To Örebro University

Purpose This study aims to analyze global prescribing patterns for analgosedation in neonates during four critical care scenarios. The research explores existing patterns, their association with geographic and sociodemographic index (SDI), and adherence to evidence-based practices.

Methods Data from a 2024 global survey of 924 responses to 28 questions were analyzed, focusing on four items for their high variability: premedication in intubation (Q17), sedation in preterm (Q19) and full-term newborns (Q23), and perinatal asphyxia (Q26). Latent class analysis (LCA) classified neonatal intensive care unit (NICU) prescriptions into patterns, assigning participants to the most likely class. Demographic variables, including geographic region and SDI, were compared using chi-square tests to assess associations.

Results Three distinct prescribing patterns emerged for each scenario. In premedication during intubation, Europe and North America predominantly used Class 1, adhering to guidelines with fentanyl, atropine, and muscle relaxants. In contrast, Class 2, standard in Asia and Latin America-Caribbean, primarily utilized fentanyl and midazolam, with rare use of atropine and muscle relaxants. For analgosedation in newborns, higher-SDI NICUs favored fentanyl, while lower-SDI NICUs preferred midazolam or morphine combinations. In perinatal asphyxia cases, fentanyl was the leading choice in Class 3, especially in Europe. Dexmedetomidine use was limited, primarily appearing in Class 1 NICUs. 

Conclusion The study highlights substantial regional variability in neonatal analgosedation, influenced by SDI and geography. Despite established guidelines, gaps in evidence-based implementation persist. These findings underscore the need for global standardization of neonatal care protocols and further research on the long-term safety of midazolam and dexmedetomidine. 

Background/ObjectiveHospitalized neonates are subjected to a high number of painful procedures every day. Cumulative poorly treated pain can have negative consequences on short and long-term outcomes, negative effects that are further amplified by infant-maternal separation. Research has shown that parents want to be part of their hospitalized infants pain management and that it is safe and effective. Yet, the implementation of parent-led pain management in neonatal care is sub-optimal. The overall aim of the project is to expand parent-led neonatal pain management, resulting in less infant pain and potentially better neonatal health outcomes, along with improved parent mental health and well-being.

Method The project is carried out by an international research group with researchers and parent representatives from Canada, Finland, Italy and Sweden, and will follow the British Research Council’s framework for complex interventions. It is organized into four work packages (WPs): Theory and concept (WP1), Identifying the problem (WP2), Developing an instrument and algorithm for self-audit (WP3), and Intervention and implementation (WP4). Principles for patient-public involvement will also be followed, with parent representatives involved in planning and designing the project and when applicable in data collection and publication of results.

ResultAn international team consisting of clinicians, researchers and parent partners across four countries have commenced initial work from WP1: writing a position paper, performing a literature review, and conducting an analysis of the concept of parent-led pain management.

ConclusionThe POP-project builds on the contribution of parents, researchers and clinicians and has the potential to improve implementation of parent-led pain management for neonates world-wide.

Background/ObjectiveHospitalized neonates are subjected to a high number of painful procedures every day. Cumulative poorly treated pain can have negative consequences on short and long-term outcomes, negative effects that are further amplified by infant-maternal separation. Research has shown that parents want to be part of their hospitalized infants pain management and that it is safe and effective. Yet, the implementation of parent-led pain management in neonatal care is sub-optimal. The overall aim of the project is to expand parent-led neonatal pain management, resulting in less infant pain and potentially better neonatal health outcomes, along with improved parent mental health and well-being.

Method The project is carried out by an international research group with researchers and parent representatives from Canada, Finland, Italy and Sweden, and will follow the British Research Council’s framework for complex interventions. It is organized into four work packages (WPs): Theory and concept (WP1), Identifying the problem (WP2), Developing an instrument and algorithm for self-audit (WP3), and Intervention and implementation (WP4). Principles for patient-public involvement will also be followed, with parent representatives involved in planning and designing the project and when applicable in data collection and publication of results.

ResultAn international team consisting of clinicians, researchers and parent partners across four countries have commenced initial work from WP1: writing a position paper, performing a literature review, and conducting an analysis of the concept of parent-led pain management.

ConclusionThe POP-project builds on the contribution of parents, researchers and clinicians and has the potential to improve implementation of parent-led pain management for neonates world-wide.

Knowledge mobilization (KM), or the practice of sharing and applying evidence, is vital to make all information collected through research actionable by all interested audiences; but, how do you design a KM strategy that is inclusive and reflective of all disciplines of science? This interactive panel dialogue will explore effective strategies for mobilizing knowledge, from basic science to practical implementation within pediatric pain. Participants will engage with experts who have successfully navigated the complexities of translating research findings into practice in a variety of pediatric pain contexts across the research continuum. Panelists will address key challenges and opportunities to engage in KM practice, including methodologies, interdisciplinary collaboration, engagement of interest holders, and communication barriers. Through short presentations and group discussions, attendees will learn about innovative approaches, tools, and frameworks that facilitate the exchange of knowledge between researchers, practitioners, policy makers, and patients. Participants will leave equipped with practical insights and action plans to enhance their own KM efforts. Join us to contribute to a dialogue that empowers evidence-based decision-making and treatment strategies, and accelerates the path from discovery to real-world application.

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.

Aim and hypothesis To explore the agreement between parentand child reported measures of somaticdistress, gastrointestinal symptoms, mentalhealth and self-rated health, in girls 9-13years old with functional abdominal pain.

Methods Secondary analysis of data from aprospective randomized controlled trialcalled the Just in TIME study (1, 2), on girlsaged 9–13 years with FunctionalAbdominal Pain Disorders (FAPDs). Weanalyzed data from instruments that bothgirls and their legal guardians answeredseparately, at study start: Childrenssomatization inventory - gastrointestinaldistress (CSSI-GI) and somatic distress(CSSI-nonGI), Self-rated health (SRH), andMental Health Symptoms (MHS).

Results Data from 121 girls (mean age 10.6 years)were analyzed, including 74 with FAPD and47 with Irritated Bowel Syndrom. For CSSI-GIthe girls reported a mean score of 6.98 (SD4.39) and the guardians 7.27 (4.31) with anintraclass correlation (ICC) of 0.84 (p<0.001).Corresponding numbers for CSSI-nonGI were8.75 (6.51) and 6.79 (5.05), ICC 0.75(p<0.001). The weighted Cohen’s kappa was0.32 (p<0.001) for SRH and for the MHS itemsthe kappa varied from 0.20 to 0.52, allsignificant.

Discussion The findings reveal good agreement forgastrointestinal and general somaticsymptoms but lower agreement whenreporting mental and general health.

Importance Understanding parent-child agreement in self-reported health measures enhances insight intohow symptoms are perceived across informants and contexts. It also informs when and forwhom a child’s self-report may be considered sufficient in clinical or research settings.

Home phototherapy is recommended as an alternative to hospital-based therapy for neonatal jaundice in otherwise healthy full-term infants. With a reliable device for transcutaneous bilirubin (TcB) measurement, bilirubin values could be monitored at home during treatment. This study aimed to examine the accuracy of TcB measurement of bilirubin levels before, during, and after home phototherapy. Patients requiring phototherapy were assigned to home (intervention) or hospital-based phototherapy (control). Transcutaneous bilirubin measurement was made at the sternum (uncovered skin) and at sacrum (covered by the diaper during treatment). Simultaneously, total serum bilirubin (TSB) level was collected through a blood sample. The agreement between TcB and TSB before, during, and after phototherapy was assessed using Bland-Altman plots. Altogether 141 patients and 856 paired bilirubin values were included. The results show that TcB measurements underestimate TSB levels. Before phototherapy, the mean difference between TcB and TSB was 75 ± 36 μmol/L at the sternum and 135 ± 39 μmol/L at sacrum, with no difference between study groups. During phototherapy, the mean difference at the sternum was larger in the control group, 105 ± 73 μmol/L, than in the intervention group, 50 ± 41 μmol/L; at sacrum, the mean difference was 125 ± 44 μmol/L, comparable in both study groups. After phototherapy, the TcB–TSB agreement improved, with a mean difference of 29 ± 33 μmol/L (sternum) and 87 ± 35 μmol/L (sacrum), and no difference between study groups. In conclusion this study shows that full-term infants who qualified for phototherapy show poor agreement between TcB measurement and TSB, suggesting that TcB measurements cannot replace measurement of TSB level before, during, or after home phototherapy.

Home phototherapy is recommended as an alternative to hospital-based therapy for neonatal jaundice in otherwise healthy full-term infants. With a reliable device for transcutaneous bilirubin (TcB) measurement, bilirubin values could be monitored at home during treatment. This study aimed to examine the accuracy of TcB measurement of bilirubin levels before, during, and after home phototherapy. Patients requiring phototherapy were assigned to home (intervention) or hospital-based phototherapy (control). Transcutaneous bilirubin measurement was made at the sternum (uncovered skin) and at sacrum (covered by the diaper during treatment). Simultaneously, total serum bilirubin (TSB) level was collected through a blood sample. The agreement between TcB and TSB before, during, and after phototherapy was assessed using Bland-Altman plots. Altogether 141 patients and 856 paired bilirubin values were included. The results show that TcB measurements underestimate TSB levels. Before phototherapy, the mean difference between TcB and TSB was 75 ± 36 μmol/L at the sternum and 135 ± 39 μmol/L at sacrum, with no difference between study groups. During phototherapy, the mean difference at the sternum was larger in the control group, 105 ± 73 μmol/L, than in the intervention group, 50 ± 41 μmol/L; at sacrum, the mean difference was 125 ± 44 μmol/L, comparable in both study groups. After phototherapy, the TcB-TSB agreement improved, with a mean difference of 29 ± 33 μmol/L (sternum) and 87 ± 35 μmol/L (sacrum), and no difference between study groups. In conclusion this study shows that full-term infants who qualified for phototherapy show poor agreement between TcB measurement and TSB, suggesting that TcB measurements cannot replace measurement of TSB level before, during, or after home phototherapy.