Related Experiment Video
Updated: Mar 26, 2026
A Preterm Rat Model for Pain Studies
Published on: February 9, 2024
The implementation of systematic pain and sedation management has no impact on outcome in extremely preterm infants
Philipp Deindl1,2, Vito Giordano2, Renate Fuiko2
1Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg Eppendorf, Germany.
Insights
Implementing a neonatal pain and sedation protocol for extremely preterm infants increased opiate use but did not alter short-term or neurodevelopmental outcomes at 12 months corrected age.
Area of Science:
- Neonatal intensive care
- Pediatric neurodevelopment
- Pain management in neonates
Background:
- Extremely preterm infants face significant short-term and long-term health challenges.
- Neonatal pain and sedation management protocols aim to improve infant outcomes.
- Evaluating the impact of such protocols is crucial for evidence-based care.
Purpose of the Study:
- To compare short-term and neurodevelopmental outcomes in extremely preterm infants before and after implementing a neonatal pain and sedation protocol.
- To assess the effect of the Vienna Protocol on opiate exposure and infant development.
Main Methods:
- Retrospective analysis of 140 extremely preterm infants from two NICUs.
- Comparison of infants before (controls) and after (intervention) protocol implementation.
- Evaluation at 12 months corrected age using Bayley Scales of Infant Development - Second Edition.
Main Results:
- Cumulative opiate dose significantly increased post-protocol implementation (15 mg/kg to 89 mg/kg).
- No significant differences were observed in mechanical ventilation, inotropic support, nutrition, growth, length of stay, or in-hospital morbidity.
- Neurodevelopmental outcomes (mental, motor, behavioral) at 12 months were similar between groups.
- Increased opiate exposure was a potential risk factor for lower behavior rating scores.
Conclusions:
- The implemented neonatal pain and sedation protocol led to increased opiate exposure.
- The protocol did not demonstrate a significant effect on in-hospital or neurodevelopmental outcomes for extremely preterm infants at 12 months.
- Further research may be needed to explore the long-term impact and optimize pain management strategies.
Aim:
This study compared the short-term and neurodevelopmental outcomes of extremely preterm infants before and after the implementation of a protocol to manage neonatal pain and sedation.
Methods:
Our study cohort comprised 140 extremely preterm infants from two neonatal intensive care units. We retrospectively analysed opiate exposure, time on mechanical ventilation, inotropic support, nutritional aspects and growth 12 months before (controls) vs 12 months after (intervention) the implementation of the Vienna Protocol for Neonatal Pain and Sedation. Infants were evaluated at the corrected age of 12 months using the Bayley Scales of Infant Development - Second Edition.
Results:
After the protocol was implemented, the cumulative opiate dose increased from a baseline of 15 mg/kg ± 41 to 89 mg/kg ± 228 morphine equivalents. Time on mechanical ventilation, inotropic support, length of parenteral nutrition, growth, length of stay and in-hospital morbidity were similar before and after the implementation, with no differences between the groups in mental, motor and behavioural development at the one-year follow-up. However, opiate exposure was a possible risk factor for lower behaviour rating scores (estimate = -0.04; p = 0.006). [Correction added on 23 February 2016, after online publication: In the preceding sentences, the cumulative opiate dose as well as the estimate value for the behavioral rating scale were previously incorrect and have been amended in this current version.]
Conclusion:
Implementing a neonatal pain and sedation protocol increased opiate exposure, but had no effect on the in-hospital and neurodevelopmental outcomes of extremely preterm infants.
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