Pain assessment and management practices in Hungarian neonatal intensive care units: a nationwide survey

Neonates hospitalized in Neonatal Intensive Care Units (NICUs) are frequently exposed to painful procedures. Despite increasing evidence regarding the adverse short- and long-term consequences of untreated neonatal pain, pain assessment and management remain inadequate worldwide. This study aimed to describe neonatal pain assessment and management practices in Hungarian level III NICUs.

A prospective multicenter cross-sectional survey was conducted between June and October 2023. An anonymous online questionnaire was distributed to the heads of all Hungarian level III NICUs.

Fourteen of the 21 Hungarian level III NICUs participated in the survey (response rate: 67%). Only 2 (14%) of NICUs reported using a comprehensive written pain management guideline, and the same two (14%) NICUs routinely used validated neonatal pain assessment scales. Non-pharmacological pain management methods were used in all units, although their type and frequency varied substantially. Reported methods included kangaroo care, breastfeeding, expressed breast milk, pacifier, facilitated tucking, sensorial saturation, music therapy, massage, oral sucrose, and co-bedding. Sucrose administration and pacifier use were the most frequently reported non-pharmacological interventions (13/14, 93% each). Postoperative analgesia was routinely administered in all surgical NICUs, while procedural analgesia, in addition to continuous opioid administration was reported by only 40% of these centers. Routine analgesia during mechanical ventilation was used in 86% of units. The most frequently prescribed medications were paracetamol for postoperative pain and fentanyl for ventilated patients. One NICU reported the use of sedatives without concomitant analgesic therapy.

Neonatal pain assessment and management practices remain inconsistent in Hungarian NICUs. These findings should be interpreted cautiously, as the study was exploratory and relied on self-reported practices, which may overestimate actual adherence to neonatal pain management recommendations. However, wider implementation of standardized guidelines, validated pain assessment tools, and evidence-based pain management strategies is warranted.