Parents of preterm neonates wish greater involvement in pain management; little is known about factors associated with this involvement. We aim to describe perceived maternal information on infants’ pain during hospitalization (PMIP), to study associations between PMIP and mothers’ attitudes during painful procedures, and to identify individual and contextual factors associated with PMIP.
Analyses of questionnaires from the French national cohort study of preterm neonates, EPIPAGE-2. PMIP was derived from mothers’ answers to questions about information perceived on both pain assessment and management.
Among 3056 eligible neonates born before 32 weeks, 1974, with available maternal reports, were included in the study. PMIP was classified as “sufficient,” “little, not sufficient,” or “insufficient, or none” for 22.7, 45.9, and 31.3% of neonates, respectively. Mothers reporting PMIP as “sufficient” were more frequently present and more likely comforting their child during painful procedures. Factors independently associated with “sufficient” PMIP were high maternal education, gestational age <29 weeks, daily maternal visits, perception of high team support, and implementation of the neonatal and individualized developmental care and assessment program.
Perceived maternal information on premature infants’ pain reported as sufficient increased maternal involvement during painful procedures and was associated with some units’ policies.
Access optionsAccess options
Subscribe to Journal
Get full journal access for 1 year
only $64.85 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Members of the Neurodevelopmental Care Study Group of EPIPAGE-2 are listed at the end of the paper.
Franck, L. S. et al. Parental concern and distress about infant pain. Arch. Dis. Child Fetal Neonatal Ed. 89, F71–F75 (2004).
Franck, L. S., Oulton, K. & Bruce, E. Parental involvement in neonatal pain management: an empirical and conceptual update. J. Nurs. Sch. 44, 45–54 (2012).
Carbajal, R. et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 300, 60–70 (2008).
Johnston, C. et al. Pain in Canadian NICUs: have we improved over the past 12 years? Clin. J. Pain 27, 225–232 (2011).
Courtois, E. et al. The burden of venipuncture pain in neonatal intensive care units: EPIPPAIN 2, a prospective observational study. Int. J. Nurs. Stud. 57, 48–59 (2016).
Franck, L. S. et al. Parent involvement in pain management for NICU infants: a randomized controlled trial. Pediatrics 128, 510–518 (2011).
Skene, C. et al. Parental involvement in neonatal comfort care. J. Obstet. Gynecol. Neonatal Nurs. 41, 786–797 (2012).
Axelin, A. et al. Neonatal Intensive care nursesʼ perceptions of parental participation in infant pain management: A Comparative Focus Group Study. J. Perinat. Neonatal Nurs. 29, 363–374 (2015).
Ancel, P.-Y. & Goffinet, F. EPIPAGE 2 Writing Group. EPIPAGE 2: a preterm birth cohort in France in 2011. BMC Pediatr. 14, 97 (2014).
Stark, A. R. American Academy of Paediatrics committee on Fetus and Newborn. Levels of neonatal care. Pediatrics 114, 1341–1347 (2004).
Ego, A. et al. Customized and non-customized French intrauterine growth curves. I—Methodology. J. Gynecol. Obstet. Biol. Reprod. 45, 155–164 (2016).
Ancel, P.-Y. & Goffinet, F. EPIPAGE-2 Writing Group, et al. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr. 169, 230–238 (2015).
Carbajal, R. et al. Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study. Lancet Respir. Med. 3, 796–812 (2015).
Pierrat, V. et al. Translating neurodevelopmental care policies into practice: the experience of neonatal ICUs in France—The EPIPAGE-2 Cohort Study. Pediatr. Crit. Care Med. 17, 957–967 (2016).
Spielberger, C. D., Bruchon-Schweitzer, M. & Paulhan I. Inventaire d’Anxiété Etat-Trait Forme Y (STAI-Y) 68 (Les Editions du Centre de Psychologie Appliquée, Paris, 1993).
Rubin, D. B. & Schenker, N. Multiple imputation in health-care databases: an overview and some applications. Stat. Med. 10, 585–598 (1991).
Provenzi, L. et al. a comparison of maternal and paternal experiences of becoming parents of a very preterm infantJ. Obstet. Gynecol. Neonatal Nurs. 45, 528–541 (2016).
Courtois, E. et al. Epidemiology and neonatal pain management of heelsticks in intensive care units: EPIPPAIN 2, a prospective observational study. Int J. Nurs. Stud. 59, 79–88 (2016).
Coughlin, M., Gibbins, S. & Hoath, S. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. J. Adv. Nurs. 65, 2239–2248 (2009).
Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. Prevention and management of procedural pain in the neonate: an update. Pediatrics 137, e20154271 (2016).
Anand, K. J. S. et al. Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr. 106, 1248–1249 (2017).
Anand, K. J. S. et al. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet 363, 1673–1682 (2004).
Giordano, V. et al. The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between other sedation levels. Acta Paediatr. 103, e515–e521 (2014).
Best, K. M.Randomized Evaluation of Sedation Titration for Respiratory Failure Baseline Study Investigators. et al. Patterns of sedation weaning in critically ill children recovering from acute respiratory failure. Pediatr. Crit. Care Med. 17, 19–29 (2016).
Harrison, D., Yamada, J. & Stevens, B. Strategies for the prevention and management of neonatal and infant pain. Curr. Pain. Headache Rep. 14, 113–123 (2010).
Rycroft-Malone, J. Implementing evidence-based practice in the reality of clinical practice. World. Evid. Based Nurs. 9, 1 (2012).
Sharek, P. J. et al. Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics 118(Suppl. 2), S78–S86 (2006).
Stevens, B. et al. The influence of context on pain practices in the NICU: perceptions of health care professionals. Qual. Health Res. 21, 757–770 (2011).
Zhu, L. M. et al. Improvements in pain outcomes in a Canadian pediatric teaching hospital following implementation of a multifaceted knowledge translation initiative. Pain. Res Manag. 17, 173–179 (2012).
Westrup, B. Family-centered developmentally supportive care. NeoReviews 15, e325–e335 (2014).
Warren, I., Mat-Ali, E., Green, M. & Nyathi, D. Evaluation of the Family and Infant Neurodevelopmental Education (FINE) programme in the UK. J. Neonatal Nurs. 25, 93–98 (2019).
Smith, G. C. et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann. Neurol. 70, 541–549 (2011).
Vinall, J. & Grunau, R. E. Impact of repeated procedural pain-related stress in infants born very preterm. Pediatr. Res. 75, 584–587 (2014).
Doesburg, S. M. et al. Neonatal pain-related stress, functional cortical activity and visual-perceptual abilities in school-age children born at extremely low gestational age. Pain 154, 1946–1952 (2013).
Ranger, M. & Grunau, R. E. Early repetitive pain in preterm infants in relation to the developing brain. Pain. Manag. 4, 57–67 (2014).
Montirosso, R. et al. Neonatal developmental care in infant pain management and internalizing behaviours at 18 months in prematurely born children. Eur. J. Pain. 20, 1010–1021 (2016).
We thank members of the EPIPAGE-2 study group and all the regional teams participating in the study for their substantial contribution to acquisition of data; Diep Tran for administration of the EPIPAGE-2 database and provision of the data; Laura Smales for her helpful contribution in providing language help. We are grateful for the participation of all families of preterm infants in the EPIPAGE-2 cohort study and for the cooperation of all maternity and neonatal units in France. This work was supported by (1) The French Institute of Public Health research/institute of Public Health and its partners: the French Health Ministry, the National institute of Health and Medical Research (INSERM). (2) The French EQUIPEX program of investments in the future coordinated by the National Research Agency. (3) The Fondation de France No. 00050329.