Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey

Abstract

Background Necrotizing enterocolitis (NEC) is a highly painful intestinal complication in preterm infants that requires adequate pain management to prevent short- and long-term effects of neonatal pain. There is a lack of international guidelines for pain management in NEC patients. Therefore, this study aims to describe current pain management for NEC patients in European neonatal intensive care units (NICUs). Methods An online survey was designed and conducted to assess current practices in pain management for NEC patients in European NICUs. The survey was distributed via neonatal societies, digital platforms, and professional contacts. Results Out of the 259 responding unique European NICUs from 36 countries, 61% had a standard protocol for analgesic therapy, 73% assessed pain during NEC, and 92% treated NEC patients with intravenous analgosedatives. There was strong heterogeneity in the used pain scales and initial analgesic therapy, which mainly included acetaminophen (70%), fentanyl (56%), and/or morphine (49%). A third of NICU representatives considered their pain assessment adequate, and half considered their analgesic therapy adequate for NEC patients. Conclusions Various pain scales and analgesics are used to treat NEC patients in European NICUs. Our results provide the first step towards an international guideline to improve pain management for NEC patients. Impact This study provides an overview of current pain management practices for infants with necrotizing enterocolitis (NEC) in European neonatal intensive care units. Choice of pain assessment tools, analgosedatives, and dosages vary considerably among NICUs and countries. A third of NICU representatives were satisfied with their current pain assessment practices and half of NICU representatives with their analgesic therapy practices in NEC patients in their NICU. The results of this survey may provide a first step towards developing a European pain management consensus guideline for patients with NEC.

Maturation of Paracetamol Elimination Routes in Preterm Neonates Born Below 32 Weeks of Gestation

“…Despite being off-label, intravenous paracetamol (PCM) is increasingly used to control mild-to-moderate pain in preterm neonates and to spare the use of opioids in severe pain [ 1 , 2 ]. Understanding the maturation in the different elimination pathways of PCM to subsequently describe the exposure of PCM and its metabolites across the heterogeneous population of preterm neonates is a necessary step towards its safe and effective use in this vulnerable population.…”

Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

“…There are more than 65 assessment scales for childhood, but only a third of them are also validated for immature neonates, and significantly less for extremely low birth weight neonates (ELBW) after major abdominal surgery in particular [3]. Moreover, the choice of pain assessment tools varies among neonatal intensive care units (NICU) and countries as described, for example, in premature neonates treated for necrotizing enterocolitis (NEC) [4]. However, not all of the listed pain scales are validated, particularly for postoperative pain in ELBW.…”

Impact of sociodemographic status of countries on neonatal analgosedation management

“…The use of pain assessment tools also largely depends on nurses training programs and their initiative within the team. 4,5 In the article by Arribas et al in Pediatric Research (2024 Feb 13. https://doi.org/10.1038/s41390-024-03032-7.…”