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  • Clinical Research Article
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Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI)

Pediatric Research (2024)Cite this article

Abstract

Background

There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress.

Methods

This was a global, prospective, cross-sectional study. A survey was distributed May–November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location.

Results

The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others.

Conclusions

Socio-economic status of countries impacts on neonatal analgosedation management.

Impact

  • There is significant variability in the pain management practices in neonates.

  • There is a lack of knowledge related to how neonatal pain management practices differ between regions.

  • Sociodemographic index is a key factor associated with differences in neonatal pain management practices across global regions.

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Fig. 1: Algorithm that represents the selection process responses during the database clearance.
Fig. 2: Comparative reported use of guidelines based on sociodemographic index (SDI).
Fig. 3: Procedures in which respondents reported using analgesia/sedation (%).

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Download references

Acknowledgements

We would like to thank all neonatal staff who took some time to share their experience responding to this survey. All contributors who shared their email will receive feedback or results. Special thanks to https://99nicu.org/, ESPR (European Society for Pediatric Research), and all pediatric and neonatal societies, who helped with the circulation of the survey.

Funding

This study was (partially) funded by the Italian Ministry of Health—Current Research IRCCS.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Neonatal Intensive Care Unit, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, Madrid, 28027, Spain

    Cristina Arribas & Felipe Garrido

  2. Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy

    Giacomo Cavallaro, Genny Raffaeli & Genny Raffaeli

  3. Department of Statistics and Operations Research, Faculty of Medicine, University of Cadiz, 11003, Cádiz, Spain

    Juan-Luis Gonzalez & Carolina Lagares

  4. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy

    Genny Raffaeli

  5. Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Anne Smits & Karel Allegaert

  6. Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium

    Anne Smits

  7. Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center—Sophia Children’s Hospital, Rotterdam, The Netherlands

    Sinno H. P. Simons & Robert B. Flint

  8. MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC + ), School for Oncology and Reproduction (GROW), Maastricht University, 6202AZ, Maastricht, The Netherlands

    Eduardo Villamor

  9. Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands

    Karel Allegaert

  10. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

    Karel Allegaert

  11. Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Abigail Kusi Amponsah

  12. Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland

    Abigail Kusi Amponsah

  13. Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands

    Agnes van den Hoogen

  14. Center for Clinical Research, Region Värmland, Karlstad, Sweden

    Alexandra Ullsten

  15. Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden

    Alexandra Ullsten, Emma Olsson & Martina Carlsen Misic

  16. Pediatric Intensive Care Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, Padova, Italy

    Angela Amigoni

  17. Department of Nursing Science, University of Turku, Turku, Finland

    Anna Axelin

  18. Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland

    Annakaija Palomaa

  19. Department of Paediatrics, University of Oxford, Oxford, United Kingdom

    Aomesh Bhatt, Caroline Hartley, Luke Baxter, Rebeccah Slater & Shellie Robinson

  20. Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway

    Arild Rønnestad & Tom Stiris

  21. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Arild Rønnestad & Tom Stiris

  22. Children and the Youth Clinic, Eskilstuna, Sweden

    Beatrice Olsson Duse

  23. Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway

    Bente Johanne Vederhus

  24. Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway

    Bente Silnes Tandberg, Flore Le Marechal & Lene Lyngstad

  25. Lovisenberg Diaconal University College, Oslo, Norway

    Bente Silnes Tandberg

  26. Department of Anesthesiology and Pain Management, Maastricht University Medical Center +, Maastricht, The Netherlands

    Bert Joosten & Mathilde Baudat

  27. Department of Anesthesiology and Pain Management, Division of Translational Neuroscience, School of Mental Health and Neuroscience (MHeNs), University Maastricht, Maastricht, The Netherlands

    Bert Joosten

  28. Department of Women’s and Children’s Health, University of Liverpool, Liverpool Health Partners, Liverpool, United Kingdom

    Charalampos Kotidis

  29. University of Liverpool, Liverpool Womens Hospital, Liverpool, United Kingdom

    Charalampos Kotidis

  30. National Perinatal Epidemiology Unit, Clinical Trials Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom

    Charles Christoph Roehr

  31. Women and Children’s, Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, Bristol, United Kingdom

    Charles Christoph Roehr

  32. Neonatal Intensive care Unit, Maxima Medical Centre, Veldhoven, The Netherlands

    Christ-Jan van Ganzewinkel

  33. Neonatal Intensive Care Unit, Clínica Universidad de Navarra, Madrid, Spain

    Cristina Arribas & Felipe Garrido

  34. Neonatal Intensive Care Unit, Imperial College NHS TRUST, London, United Kingdom

    Daniela Sofia Horta Machado

  35. Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

    Daniëlla Roofthooft & Sinno H. P. Simons

  36. Department of Neonatology, Skåne University Hospital, Lund, Sweden

    Elisabeth Norman & Hanna Ahl

  37. Department of Paediatrics, Clinical Sciences, Lund University, Lund, Sweden

    Elisabeth Norman

  38. Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Emma Olsson, Maria Gradin & Martina Carlsen Misic

  39. Department of Paediatrics and Child Health, Infant Centre, University College Cork, Cork, Ireland

    Eugene Dempsey

  40. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

    Evalotte Mörelius

  41. School of Nursing and Midwifery, Edith Cowan University, Perth, Australia

    Evalotte Mörelius

  42. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Francesca Sperotto

  43. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Francesca Sperotto

  44. Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center - Sophia Children’s Hospital, Rotterdam, The Netherlands

    Gerbrich van den Bosch & Naomi Meesters

  45. Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland

    Guðrún Kristjánsdóttir

  46. Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland

    Guðrún Kristjánsdóttir

  47. Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway

    Hans Jørgen Stensvold

  48. Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark

    Helle Haslund-Thomsen

  49. Department of Paediatrics, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Helle Haslund-Thomsen

  50. Department of Neonatology, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark

    Janne Weiss

  51. Department of Neonatology, Oslo University Hospital, Oslo, Norway

    Jannicke Hanne Andresen

  52. Department of Neonatal Medicine, University Hospital of Brest, Brest, France

    Jean-Michel Roue

  53. IC Neonatology Emma Children’s Hospital Amsterdam University Medical Center, Amsterdam, The Netherlands

    Joke Wielenga

  54. Department of Pediatrics, Division of Neonatology, Sophia Children’s Hospital, Rotterdam, The Netherlands

    Judith ten Barge

  55. Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria

    Katrin Klebermass-Schrehof

  56. Department of Neonatology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway

    Laila Kristoffersen

  57. Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway

    Laila Kristoffersen

  58. Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy

    Laura Moschino

  59. University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom

    Liam Mahoney

  60. Regional Neonatal Intensive Care Unit St. Michael’s Hospital, Bristol, United Kingdom

    Liam Mahoney

  61. Department of Maternal and Child Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland

    Magdalena Panek

  62. Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France

    Manon Tauzin

  63. Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland

    Mariaana Mäki-Asiala & Tarja Pölkki

  64. Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland

    Mariaana Mäki-Asiala & Tarja Pölkki

  65. School of Nursing, Faculty of Health, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and IWK Health, Halifax, Nova Scotia, Canada

    Marsha Campbell-Yeo

  66. Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands

    Mathilde Baudat

  67. School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Mats Eriksson

  68. Neonatal Research Group at the Health Research Institute La Fe (IISLAFE), Valencia, Spain

    Máximo Vento

  69. Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children’s Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

    Monique van Dijk

  70. Department of Internal Medicine, Division of Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

    Monique van Dijk

  71. Neonatal Intensive Care Unit, Western Health Hospital, Melbourne, Australia

    Natalia Toumbourou

  72. Neonatal Intensive Care Unit, AOU Policlinico G. Rodolico San Marco, Catania, Italy

    Nunzia Decembrino

  73. Neonatal Intensive Care Unit, Department of Critical Care, Cà Foncello Regional Hospital, Treviso, Italy

    Paola Lago

  74. Department of Health Sciences, Lund University, Lund, Sweden

    Pia Lundqvist

  75. Department of Research, Telemark Hospital Trust, Skien, Norway

    Randi Dovland Andersen

  76. Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), The Faculty of Medicine, University of Oslo, Oslo, Norway

    Randi Dovland Andersen

  77. Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau-Sorbonne Université, Paris, France

    Ricardo Carbajal

  78. Institut National de La Santé et de La Recherche Médicale, Paris, France

    Ricardo Carbajal

  79. Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Rikke Louise Stenkjær

  80. Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands

    Robert B. Flint & Samir El Abdouni

  81. Clinical Epidemiology and Biostatistics, Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Scott Montgomery

  82. Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden

    Scott Montgomery

  83. Department of Epidemiology and Public Health, University College London, London, United Kingdom

    Scott Montgomery

  84. Department of Pediatrics, Section of Neonatology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, İstanbul, Turkey

    Serdar Beken

  85. Division of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey

    Sezin Ünal

  86. Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom

    Shalini Ojha

  87. Neonatal Unit, University Hospitals of Derby and Burton NHS Trust, Derby, United Kingdom

    Shalini Ojha

  88. Faculty of Nursing, University of Iceland, Reykjavik, Iceland

    Sigríður María Atladóttir

  89. Neonatal Intensive Care Unit, Lanspitali University Children’s Hospital, Reykjavik, Iceland

    Sigríður María Atladóttir

  90. Neonatal Intensive Care Unit, University UZ Brussel, Brussels, Belgium

    Sofie Pirlotte

  91. Department of Paediatric and Adolescent Medicine Neonatal Intensive Care Unit Drammen Hospital Vestre Viken Hospital Trust, Drammen, Norway

    Solfrid Steinnes

  92. Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands

    Swantje Völler

  93. Department of Pediatrics, Oulu University Hospital, Oulu, Finland

    Tiina Ukkonen

  94. Neonatal Intensive Care Unit, CHI Créteil, Créteil, France

    Xavier Durrmeyer

Authors
  1. Cristina Arribas
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  2. Giacomo Cavallaro
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  3. Juan-Luis Gonzalez
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  4. Carolina Lagares
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  5. Genny Raffaeli
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  6. Anne Smits
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  7. Sinno H. P. Simons
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  8. Eduardo Villamor
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  9. Karel Allegaert
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  10. Felipe Garrido
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Consortia

on behalf of the ESPR Special Interest Group for Neonatal Pain

  • Abigail Kusi Amponsah
  • , Agnes van den Hoogen
  • , Alexandra Ullsten
  • , Angela Amigoni
  • , Anna Axelin
  • , Annakaija Palomaa
  • , Anne Smits
  • , Aomesh Bhatt
  • , Arild Rønnestad
  • , Beatrice Olsson Duse
  • , Bente Johanne Vederhus
  • , Bente Silnes Tandberg
  • , Bert Joosten
  • , Caroline Hartley
  • , Charalampos Kotidis
  • , Charles Christoph Roehr
  • , Christ-Jan van Ganzewinkel
  • , Cristina Arribas
  • , Daniela Sofia Horta Machado
  • , Daniëlla Roofthooft
  • , Elisabeth Norman
  • , Emma Olsson
  • , Eugene Dempsey
  • , Evalotte Mörelius
  • , Felipe Garrido
  • , Flore Le Marechal
  • , Francesca Sperotto
  • , Genny Raffaeli
  • , Gerbrich van den Bosch
  • , Giacomo Cavallaro
  • , Guðrún Kristjánsdóttir
  • , Hanna Ahl
  • , Hans Jørgen Stensvold
  • , Helle Haslund-Thomsen
  • , Janne Weiss
  • , Jannicke Hanne Andresen
  • , Jean-Michel Roue
  • , Joke Wielenga
  • , Judith ten Barge
  • , Karel Allegaert
  • , Katrin Klebermass-Schrehof
  • , Laila Kristoffersen
  • , Laura Moschino
  • , Lene Lyngstad
  • , Liam Mahoney
  • , Luke Baxter
  • , Magdalena Panek
  • , Manon Tauzin
  • , Maria Gradin
  • , Mariaana Mäki-Asiala
  • , Marsha Campbell-Yeo
  • , Martina Carlsen Misic
  • , Mathilde Baudat
  • , Mats Eriksson
  • , Máximo Vento
  • , Monique van Dijk
  • , Naomi Meesters
  • , Natalia Toumbourou
  • , Nunzia Decembrino
  • , Paola Lago
  • , Pia Lundqvist
  • , Randi Dovland Andersen
  • , Rebeccah Slater
  • , Ricardo Carbajal
  • , Rikke Louise Stenkjær
  • , Robert B. Flint
  • , Samir El Abdouni
  • , Scott Montgomery
  • , Serdar Beken
  • , Sezin Ünal
  • , Shalini Ojha
  • , Shellie Robinson
  • , Sigríður María Atladóttir
  • , Sinno H. P. Simons
  • , Sofie Pirlotte
  • , Solfrid Steinnes
  • , Swantje Völler
  • , Tarja Pölkki
  • , Tiina Ukkonen
  • , Tom Stiris
  •  & Xavier Durrmeyer

Contributions

Conceptualization: C.A., F.G., E.V., K.A., G.C. Methodology: C.A., F.G., G.C., K.A. Software: F.G., G.C. Validation, K.A., E.V., C.A., G.R. Formal analysis: C.A., F.G., C.L., J.L.G. Investigation: F.G., C.A., G.C., G.R. Resources: F.G., C.A., G.C. Data curation: F.G., C.L., J.L.G., C.L. Writing—original draft preparation: F.G., C.A., J.L.G., G.C. Writing—review and editing, F.G., G.C., G.R., K.A., E.V., A.S., S.S., C.L., J.L.G. Supervision: K.A., E.V. Funding acquisition, F.G., G.C. All authors have read and agreed to the published version of the manuscript. Major revisions edited by: F.G., J.L.G., G.C.

Corresponding author

Correspondence to Giacomo Cavallaro.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Patients’ consent was not required to perform this study, as confirmed by the Ethics Committee, as patients are not involved. The certificate of this Committee can be downloaded at https://doi.org/10.5061/dryad.1zcrjdfzb.

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Arribas, C., Cavallaro, G., Gonzalez, JL. et al. Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI). Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03032-7

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  • DOI: https://doi.org/10.1038/s41390-024-03032-7

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