Onwelbevinden en pijn bij neonaten met spina bifida

Objective

In the debate on the active ending of the lives of newborn infants, proponents refer to newborns with very severe forms of spina bifida and their assumed suffering. They claim that there is no effective treatment to alleviate this suffering. Nevertheless, the degree of discomfort and pain in such newborns has never been assessed in a validated manner.

Design

Prospective cohort study.

Method

Newborns with spina bifida who were admitted to the Sophia Children s Hospital in Rotterdam, the Netherlands, during the period between 1 January 2005 and 1 January 2010 were monitored before and after their initial treatment. We formed two groups on the basis of the severity of spina bifida which was determined in accordance with the Lorber criteria. The primary outcome measure was a combination of the scores for discomfort, as assessed by the Comfort behavioural (Comfort-B) scale, and pain, assessed by a visual analogue scale. These combined scores were coupled to a validated and evidence-based analgesia algorithm.

Results

A total of 28 newborns were included. In 3.3% of the scores, discomfort was related to pain. This percentage did not differ much between the pre- and post-operative period and there was no significant difference between newborns with severe spina bifida or a less severe form (3.9 vs. 2.8%; p = 0.3). The mean dosage for paracetamol was 35 mg/kg per day (95% CI: 32-39) and for morphine, 0.9 μg/kg per hour (95% CI: 0.6-1.2).

Conclusion

During the entire hospital stay, all newborns with spina bifida showed low levels of discomfort and pain, independent of the severity of the condition or whether or not the laesion had been closed.

Conflict of interest: none declared. Financial support: none declared.