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A Comparison of Health Care Workers Assessment and Management of Pain between a Neonatal Intensive Care Unit in India and Norway

Sukhjeet Kaur Bains, Praveen Kumar, Venkataseshan Sundaram, Astri Lang, Ola Didrik Saugstad

Abstract Objective: Describe and compare health care worker´s assessment and management of neonatal procedural pain at one Neonatal Intensive Care Unit (NICU) in India (PGI: Post Graduate Institute of Medical Education and Research) one in Norway (OUH-U: Oslo University Hospital Ullevaal), and to investigate factors influencing the assessment and compare the management with international guidelines. Methods: A survey was conducted among NICU staff at both institutions assessing how painful specific neonatal procedures were considered to be using the Visual Analog Score (VAS). Kruskal Wallis H- and Mann-Whitney tests were performed for analysis. Procedural pain management protocols at the NICUs were obtained by interview. Results: There was a significant difference between the units in assessment of subjective pain intensity for the highest and moderately perceived painful procedures [Mean rank PGI - OUH-U (χ2): 26.04-43.47 (13.291); P = 0.000 and 28.34-41.03 (6.997); P = 0.008 respectively]. In group 3, females rated higher pain intensity than men [Mean rank (χ2): 37.85-25.87 (5.062). No significant difference was found for procedures within the low-pain category and factors such as age, profession, professional experience, and having own children. Procedural pain management differed between the two units, yet was not in accordance with guidelines from UpToDate. Conclusion: Overall, pain recognition and pain management, specifically in the PGI NICU, was low, not consistent with current recommendations. These findings should serve as the basis for quality improvement interventions for both units. This difference also deserves exploration to identify the reasons and its impact on pain management at the NICUs.