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. 2025 May 14;184(6):342.
doi: 10.1007/s00431-025-06168-8.

Pain management in preterm infants with necrotizing enterocolitis: an international expert consensus statement

Judith A Ten Barge  1 , Gerbrich E van den Bosch  2 , Karel Allegaert  3   4   5 , Aomesh Bhatt  6 , Nicola Brindley  7 , Dearbhla Byrne  8 , Marsha Campbell-Yeo  9 , Marta Camprubi-Camprubi  10 , Giacomo Cavallaro  11 , Xavier Durrmeyer  12   13 , Nicholas Embleton  14 , Mats Eriksson  15 , Robert B Flint  2   5 , Felipe Garrido  16 , Maria Lorella Giannì  11   17 , Eric Giannoni  18 , Heather Kitt  6 , Daphne Klerk  19 , Guðrún Kristjánsdóttir  20 , Abigail Kusi Amponsah  21 , Alexandre Lapillonne  22   23 , Camilia R Martin  24 , Melinda Matyas  25 , Elisabeth Norman  26 , Shalini Ohja  27 , Sofie Pirlotte  28 , Ruth Del Rio  29 , Jean-Michel Roué  30 , Catarina Sevivas  10   31 , Rebeccah Slater  6 , Anne Smits  3   32 , Miguel Saenz de Pipaon  33 , Manon Tauzin  12 , Tiina Ukkonen  34   35 , Sezin Unal  36 , Eduardo Villamor  37 , Eleanor J Molloy  8   38   39   40   41 , Sinno H P Simons  2
Affiliations

Pain management in preterm infants with necrotizing enterocolitis: an international expert consensus statement

Judith A Ten Barge et al. Eur J Pediatr. .

Abstract

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.

Keywords: Necrotizing enterocolitis; Pain management; Preterm infants.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Suggested steps in analgesic therapy for infants with NEC. Non-pharmacological approaches should be considered in all stages
Fig. 2
Fig. 2
Research agenda for improving pain management in infants with NEC
See this image and copyright information in PMC

References

    1. Alsaied A, Islam N, Thalib L (2020) Global incidence of necrotizing enterocolitis: a systematic review and meta-analysis. BMC Pediatr 20:344 - PMC - PubMed
    1. Jones IH, Hall NJ (2020) Contemporary outcomes for infants with necrotizing enterocolitis-a systematic review. J Pediatr 220(86–92):e83 - PubMed
    1. Roberts AG, Younge N, Greenberg RG (2024) Neonatal necrotizing enterocolitis: an update on pathophysiology, treatment, and prevention. Paediatr Drugs 26(3):259–275 - PubMed
    1. Ballance WA, Dahms BB, Shenker N, Kliegman RM (1990) Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr 117:S6-13 - PubMed
    1. Ten Barge JA, Vermeulen MJ, Simons SHP, van den Bosch GE (2022) Pain management for necrotizing enterocolitis: getting the balance right. Pediatr Res 92:1423–1431 - PMC - PubMed

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