Pain treatment in neonates – a Polish multicentre survey conducted in 2014

Introduction
Preventing pain before and during medical procedures is a basic human right, regardless of age. Painful invasive procedures are frequently performed on infants admitted to neonatal units.

Aim of the study
The aim of this study was to describe current neonatal pain management in Polish neonatal units according to the opinions of physicians.

Material and methods
A survey of 100 Polish neonatal units was performed. Physicians were asked to complete a researcher-developed questionnaire. The survey comprised 40 questions. The frequency of use of selected pain medicines and pain treatment according to guidelines was assessed using Likert-scale questions.

Results
Seventy-six units agreed to participate in the study. Data were available from 235 physicians. Most neonatal units did not have guidelines for the treatment of pain in newborns. There was no significant correlation between theoretical knowledge and pain treatment in accordance with the guidelines (r = –0.04, p = 0.6). Pain treatment before selected procedures seems to be insufficient. The study revealed the frequent use of paracetamol before painful procedures. Before central line insertion 42% of physicians from level III units very often or often administered paracetamol. About 40% of physicians used paracetamol before chest tube insertion. Phenobarbital intravenous/per os/per rectum was the most frequently used drug (76% of respondents from level III NICU). Almost 60% of physicians did not use written guidelines for pain management, but they followed their experience.

Conclusions
Despite changes in the approach to pain management in neonates and the widespread availability of recommendations, pain treatment in Polish neonatal units is still insufficient. There is a need for the education of health professionals on neonatal pain management. This study suggests that Polish neonatal units need national guidelines for pain management.