Understanding the Prevailing Practices of Pain Management in Extremely Preterm Neonates During the First 14 days of NICU Stay
Understanding the Prevailing Practices of Pain Management in Extremely Preterm Neonates During the First 14 days of NICU StaySanty N Sajan PhD, MBA, MSN, RNCurrently neonates as young as 23 weeks are considered viable and are admitted to the neonatal intensive care units (NICU) for life support. Many of the supportive activities in these units are both invasive and painful, yet little is known about the experience of pain in the extremely preterm neonate of 23-28 weeks of gestational age. Preterm neonates are often very unstable with immature physiology and organ systems; therefore the management of pain in these extremely preterm neonates creates unique challenges to the entire healthcare team.The purpose of this research study is to describe both pharmacologic and non-pharmacologic pain management strategies in extremely preterm neonates. The ultimate goal of this study is to contribute to the body of knowledge on procedural pain management in extremely preterm neonates, and provide evidence for clinical guidelines and the need for further research.This research study implements a normative case series methodology, using a descriptive, correlational analysis. The sample consisted of 28 extremely preterm neonates between the gestational ages of 23-28 weeks. Logistic regression was used in this study to determine the likelihood that painful procedures would be managed by either pharmacologic or non-pharmacologic interventions.The equation that was used estimated was:Equation: Log (p/1-p) = â0 + â1*x1 + â2*x2 +â3*x3Where: p=the probability of pharmacologic intervention, â0 = constant; x1 = highly painful procedures; x2 = moderately painful procedures; x3 = least painful procedures.This study found that most painful procedures were performed without adequate analgesic measures. The normative conceptual framework used in this study highlights that the current pain management scenario in this vulnerable population is suboptimal and should not be the norm in this population. Some of these uncertainties can be reduced by drawing attention to conducting further research and developing guidelines and policies for creating an optimal standard for pain management in this vulnerable population.
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