title: Infants Operated on for Necrotizing Enterocolitis: Towards Evidence-Based Pain Guidelines.
abstract: Necrotizing enterocolitis (NEC) is known as an extremely painful childhood condition.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Meesters
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.forename: Catherijne A J
authors.initials: CA
authors.lastname: Knibbe
authors.forename: Claudia M G
authors.initials: CM
authors.lastname: Keyzer-Dekker
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Sinno H P
authors.initials: SH
authors.lastname: Simons
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001724:Birth Weight; D020345:Enterocolitis, Necrotizing / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D009020:Morphine / Q000008:administration & dosage; D009426:Netherlands; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010166:Palliative Care; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008874:Midazolam; D005283:Fentanyl