title: Discomfort and pain in newborns with myelomeningocele: a prospective evaluation.
abstract: OBJECTIVE
  In a worldwide debate on deliberately terminating the lives of newborns, proponents point at newborns with very severe forms of myelomeningocele (MMC) and their assumed suffering, claiming there are no effective means of alleviating their distress. Nevertheless, the degree of discomfort and pain in these newborns has never been assessed in a structured manner.
  
  
  METHODS
  In a prospective cohort study, 28 consecutive newborns with MMC were included over a 5-year period and were followed up throughout their hospital stay for initial treatment. We created 2 disease severity groups on the basis of the Lorber criteria. The primary outcomes were discomfort and pain, assessed by simultaneously scoring 2 validated scales: the visual analog scale for pain and the Comfort Behavioral Scale for discomfort. These scores were coupled to a validated and evidence-based analgesia algorithm.
  
  
  RESULTS
  Overall, discomfort related to pain was measured in 3.3% of the scores. This percentage differed little between the preoperative and postoperative periods and did not significantly differ between newborns with less severe MMC and severe MMC (3.9% vs 2.8%; P = .3). The mean dosage of paracetamol was 35 mg/kg per day (95% confidence interval: 32-39); the mean dosage of morphine was 0.9 μg/kg per hour (95% confidence interval: 0.6 -1.2).
  
  
  CONCLUSIONS
  Over the length of their hospital stays for initial treatment, all newborns with MMC presented with low levels of discomfort and pain independent of disease severity and time frame.
authors.affiliation: Department of Neurosurgery, Erasmus MC, Sophia Children’s Hospital, Rotterdam, Netherlands.
authors.forename: Myrthe J
authors.initials: MJ
authors.lastname: Ottenhoff
authors.forename: Ruben
authors.initials: R
authors.lastname: Dammers
authors.forename: Erwin J O
authors.initials: EJ
authors.lastname: Kompanje
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: T H Rob
authors.initials: TH
authors.lastname: de Jong
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001724:Birth Weight; D015331:Cohort Studies; D016001:Confidence Intervals; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D009020:Morphine / Q000008:administration & dosage; D009426:Netherlands; D010147:Pain Measurement / Q000187:drug effects*; D017288:Pain Threshold / Q000187:drug effects; D011182:Postoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine