• Emilie Courtois, Stéphanie Droutman, Jean-François Magny, Zied Merchaoui, Xavier Durrmeyer, Camille Roussel, Valérie Biran, Sergio Eleni, Gaëlle Vottier, Sylvain Renolleau, Luc Desfrere, Florence Castela, Nicolas Boimond, Djamel Mellah, Pascal Bolot, Anne Coursol, Dominique Brault, Hélène Chappuy, Patricia Cimerman, Kanwaljeet J S Anand, and Ricardo Carbajal.
• Emergency Department, Hôpital Armand-Trousseau, Paris, France; Inserm UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, France. Electronic address: emilie.courtois@trs.aphp.fr.
• Int J Nurs Stud. 2016 Jul 1; 59: 79-88.

BackgroundHeelstick is the most frequently performed skin-breaking procedure in the neonatal intensive care units (NICUs). There are no large multicenter studies describing the frequency and analgesic approaches used for heelsticks performed in NICUs.ObjectivesTo describe the frequency of heelsticks and their analgesic management in newborns in the NICU. To determine the factors associated with the lack of specific preprocedural analgesia for this procedure.DesignEPIPPAIN 2 (Epidemiology of Procedural PAin In Neonates) is a descriptive prospective epidemiologic study.SettingAll 16 NICUs in the Paris region in France.ParticipantsAll newborns in the NICU with a maximum corrected age of 44 weeks +6 days of gestation on admission who had at least one heelstick during the study period were eligible for the study. The study included 562 newborns.MethodsData on all heelsticks and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011 to July 12, 2011. Newborns were followed from their admission to the 14th day of their NICU stay or discharge, whichever occurred first.ResultsThe mean (SD) gestational age was 33.3 (4.4) weeks and duration of participation was 7.5 (4.4) days. The mean (SD; range) of heelsticks per neonate was 16.0 (14.4; 1-86) during the study period. Of the 8995 heelsticks studied, 2379 (26.4%) were performed with continuous analgesia, 5236 (58.2%) with specific preprocedural analgesia. Overall, 6764 (75.2%) heelsticks were performed with analgesia (continuous and/or specific). In a multivariate model, the increased lack of preprocedural analgesia was associated with female sex, term birth, high illness severity, tracheal or noninvasive ventilation, parental absence and use of continuous sedation/analgesia.ConclusionsHeelstick was very frequently performed in NICUs. Although, most heelsticks were performed with analgesia, this was not systematic. The high frequency of this procedure and the known adverse effects of repetitive pain in neonates should encourage the search of safe and effective strategies to reduce their number.Copyright © 2016 Elsevier Ltd. All rights reserved.

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