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Infants Operated on for Necrotizing Enterocolitis: Towards Evidence-Based Pain Guidelines
Naomi J Meesters1, Monique van Dijk, Catherijne A J Knibbe
1Division of Neonatology, Department of Pediatrics, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Background:
Necrotizing enterocolitis (NEC) is known as an extremely painful childhood condition.
Objectives:
The objective of this study was to explore pain management around NEC-related surgery in our neonatal intensive care unit (NICU) from a chart review of prospectively collected data on 60 operated NEC patients admitted between 2008 and 2013 with a median (IQR) gestational age of 28.3 (25.5-31.6) weeks.
Methods:
Pain medication data and pain scores (i.e. COMFORTneo and Numerical Rating Scale pain and distress scores) from 72 h before until 72 h after surgery were collected.
Results:
Preoperatively, 95% of the patients received morphine versus 100% postoperatively, with a median dosage of 10.0 (IQR 9.7-14.5) and 16.9 (IQR 10.1-20.0) μg/kg/h, respectively. Postoperatively, 28 patients (46.7%) received additional fentanyl intermittently and 14 (23.3%) received midazolam, which was part of palliative treatment for 6 patients (42.9%). In patients receiving pain medication, median COMFORTneo scores were 10 (IQR 10-11) preoperatively and 11 (10-12) postoperatively. The pain scores were comparable with those of other patients admitted to the NICU in the same time period.
Conclusions:
Continuous morphine of 10 μg/kg/h preoperatively, with an increase to 15 μg/kg/h postoperatively, seems to constitute a good starting dose for further individualized pain management guided by pain scores.
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