Procedural pain in neonatal units in Kenya

Document Type



Paediatrics and Child Health (East Africa)


Objectives: To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya.

Design: Cross-sectional survey.

Setting: Level I and level II neonatal units in Kenya.

Patients: Ninety-five term and preterm neonates from seven neonatal units.

Methods: Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure.

Results: Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1–12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1–6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0–6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neonates admitted in level II neonatal units had a higher number of painful procedures than those admitted in level I units (mean 4.76 vs 2.96). Only one procedure had a pain intensity score documented; and none had been performed with any form of analgesia.

Conclusions: Neonates in Kenya were exposed to numerous tissue-damaging and non-tissue-damaging procedures without any form of analgesia. Our findings suggest that education is needed on how to assess and manage procedural pain in neonatal units in Kenya.


This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Archives of disease in childhood. Fetal and neonatal edition