A Prospective Study of Pain Experience in a Neonatal Intensive Care Unit of China

Objectives: To assess pain burden in neonates during their hospitalization in China and thus provide evidence for the necessity of neonatal pain management. Patients and Methods: The Neonatal Facial Coding System was used to evaluate pain in neonates. We prospectively collected data of all painful procedures performed on 108 neonates (term, 62; preterm, 46) recruited from admission to discharge in a neonatal intensive care unit of a university-affiliated hospital in China. Results: We found that during hospitalization each preterm and term neonate was exposed to a median of 100.0 (range, 11 to 544) and 56.5 (range, 12 to 249) painful procedures, respectively. Most of the painful procedures were performed within the first 3 days. Preterm neonates, especially those born at 28 and 29 weeks' gestational age, experienced more pain than those born at 30 weeks' gestation or later (P < 0.001). Among those painful procedures, tracheal aspiration was the most frequently performed on preterm neonates, and intravenous cannulation was the most common for term neonates. Moreover, tracheal intubations and femoral venous puncture were found to be the most painful. Notably, none of the painful procedures was accompanied by analgesia. Conclusions: Neonates, particularly preterm neonates, were exposed to numerous invasive painful procedures without appropriate analgesia in hospitals in China. The potential long-term impacts of poorly treated pain in neonates call for a change in pediatric practice in China and in countries with similar practices.