Procedural Pain in Hospitalized Neonates in Kenya

Abstract

Purpose: The study was conducted to understand the nature and frequency of painful procedures and use of analgesia in neonatal units in Kenya.

Design and methods: Descriptive prospective study was conducted in a regional Level I and a university-affiliated Level II neonatal unit in Western Kenya. Two hundred term and preterm neonates who were hospitalized during the first day of life were recruited. A validated checklist was used to audit medical charts of hospitalized neonates. Painful procedures and pain treatment interventions accompanying all procedures performed during the first seven days of hospitalization were documented. Descriptive statistics, t-tests and χ² were usedto determine frequency and factors influencing the frequency of procedures.

Results: A total of 1693 painful procedures (mean = 1.6 ± 1.1) were performed with most of them being tissue-damaging (n = 1291) including intravenous cannulation and intramuscular injection. Neonates were less likely to undergo procedures if there were born at term (RR 0.85; 95% CI, 0.76-0.95, p = .003) but more likely to experience procedures if admitted in a higher level of care (RR 1.57, 95% CI, 1.43-1.74, p < .001). Only one procedure was accompanied by analgesia.

Conclusions: Neonates underwent few but highly invasive procedures without analgesia. Prematurity and a high level of care predisposed neonates to a higher burden of pain.

Implications: Our findings underscore the urgent need for development of context-specific clinical practice guidelines on procedural pain treatment in sub-Saharan Africa.

Keywords: Analgesia; Kenya; Neonates; Pain; Procedures.