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Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey
Judith A Ten Barge1, Gerbrich E van den Bosch2, Naomi J Meesters2
1Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam, The Netherlands. j.tenbarge@erasmusmc.nl.
Insights
Pain management for necrotizing enterocolitis (NEC) in European NICUs shows significant variation. This study highlights the need for standardized guidelines to improve care for preterm infants with NEC.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Pain Management
Background:
- Necrotizing enterocolitis (NEC) is a severe intestinal complication in preterm infants.
- Effective pain management is crucial to mitigate short- and long-term consequences of neonatal pain.
- Current international guidelines for NEC pain management are lacking.
Purpose of the Study:
- To describe current pain management practices for NEC patients in European neonatal intensive care units (NICUs).
- To identify variations in pain assessment and analgesic therapy for NEC.
- To lay the groundwork for developing international pain management guidelines for NEC.
Main Methods:
- An online survey was distributed to European NICUs.
- The survey assessed current practices in pain management for NEC patients.
- Data were collected from 259 unique NICUs across 36 European countries.
Main Results:
- 61% of NICUs had a standard protocol for analgesic therapy; 73% assessed pain during NEC.
- Significant heterogeneity was observed in pain scales and initial analgesic choices (acetaminophen, fentanyl, morphine).
- Only one-third of NICUs considered their pain assessment adequate, and half deemed their analgesic therapy sufficient.
Conclusions:
- European NICUs exhibit considerable variation in pain management strategies for NEC patients.
- The findings underscore the need for a European consensus guideline to standardize NEC pain management.
- This survey represents a crucial first step toward improving pain control in infants with NEC.
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.
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