To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU).
Prospective observational study.
Three tertiary level NICUs in Canada.
114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures.
Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions.
114 neonates at high (Cohort A, n=35), moderate (Cohort B, n=25) and low (Cohort C, n=54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (pA, B>C, p