Pain management in preterm infants with necrotizing enterocolitis: an international expert consensus statement.
Por:
Ten Barge JA, van den Bosch GE, Allegaert K, Bhatt A, Brindley N, Byrne D, Campbell-Yeo M, Camprubí-Camprubí M, Cavallaro G, Durrmeyer X, Embleton N, Eriksson M, Flint RB, Garrido F, Giannì ML, Giannoni E, Kitt H, Klerk D, Kristjánsdóttir G, Amponsah AK, Lapillonne A, Martin CR, Matyas M, Norman E, Ohja S, Pirlotte S, del Río-Florentino R, Roué JM, Catarina Sevivas Fontoura, Slater R, Smits A, de Pipaon MS, Tauzin M, Ukkonen T, Unal S, Villamor E, Molloy EJ and Simons SHP
Publicada:
14 may 2025
Ahead of Print:
14 may 2025
Resumen:
Necrotizing enterocolitis (NEC) is probably the most painful intestinal disease affecting infants born preterm. NEC is known to cause highly severe and prolonged pain that has been associated with adverse short- and long-term effects. However, research on pain management in infants with NEC is scarce. This is likely due to its low incidence and very acute occurrence. As a result, the optimal pain management for these vulnerable infants remains unknown, and analgesic therapy practices are highly variable. Therefore, we aimed to establish expert-based consensus recommendations on pain management for NEC. Experts of the European Society for Paediatric Research (ESPR) Special Interest Groups on Neonatal pain and NEC were invited to participate in two consensus meetings. Prior to the first hybrid consensus meeting, an online survey provided input for potential recommendations. During the consensus meetings, experts shared clinical expertise and voted on recommendations. An expert consensus statement, comprising nine recommendations on optimal pain assessment and pain treatment in infants with NEC, was developed. Expert recommendations included regular pain assessments with a neonatal pain scale with additional assessments on indication and pre-emptive administration of analgesic therapy (e.g., paracetamol and an opioid) in infants with NEC stage = II. CONCLUSION: This expert consensus statement provides clinical recommendations essential for any healthcare professional caring for premature infants with NEC. The recommended guidance this statement provides on pain management strategies is key to preventing and reducing pain in this vulnerable population. WHAT IS KNOWN: • Necrotizing enterocolitis (NEC) is a very painful disease, making effective pain management essential. • Current pain management practices for infants with NEC are highly variable. WHAT IS NEW: • This expert consensus statement provides recommendations on optimal pain assessment and pain treatment in infants with NEC. • These clinical recommendations may help better prevent pain in these vulnerable infants.
Filiaciones:
Ten Barge JA:
Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
van den Bosch GE:
Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
Allegaert K:
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
Bhatt A:
Department of Paediatrics, University of Oxford, Oxford, UK
Brindley N:
Department of Surgical Paediatrics, Royal Hospital For Sick Children, Glasgow, UK
Byrne D:
Discipline of Paediatrics, Trinity College Dublin, Dublin, Ireland
Campbell-Yeo M:
School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
Camprubí-Camprubí M:
Department of Neonatology, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
Cavallaro G:
Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Durrmeyer X:
Neonatal Intensive Care Unit, CHI Créteil, Créteil, France
Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, Créteil, France
Embleton N:
Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
Eriksson M:
Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
Flint RB:
Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
Garrido F:
Department of Pediatrics, Clínica Universidad de Navarra, Madrid, Spain
Giannì ML:
Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
Giannoni E:
Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Kitt H:
Department of Paediatrics, University of Oxford, Oxford, UK
Klerk D:
Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Kristjánsdóttir G:
Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
Amponsah AK:
Department of Public Health Nursing, School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Lapillonne A:
Department of Neonatology, Necker-Enfants Malades University Hospital, APHP, Paris, France
Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
Martin CR:
Division of Neonatology, Weill Cornell Medicine, New York, NY, USA
Matyas M:
Department of Neonatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Norman E:
Pediatrics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
Ohja S:
Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
Pirlotte S:
Neonatology, UZ Brussel, Jette, Belgium
del Río-Florentino R:
Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
Roué JM:
Department of Neonatal Medicine, University Hospital of Brest, Brest, France
Catarina Sevivas Fontoura:
Department of Neonatology, BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
Neonatology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), RICORS, Santiago de Compostela, Spain
Slater R:
Department of Paediatrics, University of Oxford, Oxford, UK
Smits A:
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
de Pipaon MS:
Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
Tauzin M:
Neonatal Intensive Care Unit, CHI Créteil, Créteil, France
Ukkonen T:
Research Unit of Clinical Medicine, and MRC Oulu, University of Oulu, Oulu, Finland
Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
Unal S:
Division of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey
Villamor E:
MosaKids Children's Hospital, Maastricht University Medical Center (MUMC +), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
Molloy EJ:
Discipline of Paediatrics, Trinity College Dublin, Dublin, Ireland
Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
Neurodisability, Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland
Neonatology, CHI at Crumlin, Dublin, Ireland
Paediatrics, Coombe Hospital, Dublin, Ireland
Simons SHP:
Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
Green Submitted, Green Published, Green Accepted, hybrid
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