• Valentina Losacco, Marina Cuttini, Gorm Greisen, Dominique Haumont, Carmen R Pallás-Alonso, Veronique Pierrat, Inga Warren, Bert J Smit, Björn Westrup, Jacques Sizun, and ESF Network.
• Unit of Epidemiology, Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio 4, Rome, Italy.
• Arch. Dis. Child. Fetal Neonatal Ed. 2011 Jan 1; 96 (1): F65-8.

ObjectiveTo describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations.MethodsInformation on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with ≥50 very low birth weight admissions per year were included in this analysis.ResultsUse of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures.ConclusionsHeel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance with published guidelines is needed for clinical and ethical reasons.

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