Summary of findings 1. Continuous infusion compared to bolus administration for postoperative pain in neonates.
| Continuous infusion compared to bolus administration for postoperative pain in neonates | ||||||
| Patient or population: postoperative pain in neonates Setting: neonatal intensive care units Intervention: continuous infusion Comparison: bolus administration | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with bolus administration | Risk with continuous infusion | |||||
| Pain assessed with visual analogue scale (VAS) during the administration of selected drugs (neonates from 0 to 4 weeks) VAS scale ranges from 0 to 10 (worst) |
The mean pain assessed with VAS was 1.3 | The mean pain assessed with VAS was 1.3 | MD 0 (0.23 lower to 0.23 higher) | 133 (2 RCTs) | ⊕⊝⊝⊝ Very low a,b | We are uncertain whether opioid continuous infusion reduces pain assessed with a visual analogue scale (VAS) compared with bolus administration due to imprecision of the estimate and limitations in study design. |
| Pain assessed with COMFORT scale during the administration of selected drugs (neonates from 0 to 4 weeks) COMFORT scale ranges from 6 to 30 (worst) |
The pain assessed with COMFORT ranged from 12.8 to 17.3 | The pain assessed with COMFORT ranged from 12.6 to 17.4 | MD 0.07 lower (0.89 lower to 0.75 higher) | 133 (2 RCTs) | ⊕⊝⊝⊝ Very low a,b | We are uncertain whether opioid continuous infusion reduces pain assessed with the COMFORT scale compared with bolus administration due to imprecision of the estimate and limitations in study design. |
| All‐cause mortality during initial hospitalization ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | This outcome was not reported |
| Major neurodevelopmental disability in children aged 18 to 24 months or three to five years old ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | This outcome was not reported |
| Cognitive and educational outcomes in children more than five years old ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | This outcome was not reported |
| Severe (defined as stage 3 or greater) retinopathy of prematurity ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | This outcome was not reported |
| Severe (grade 3 or greater) intraventricular hemorrhage (IVH) on cranial ultrasound ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | This outcome was not reported |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RR: risk ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
VAS: visual analogue scale IVH: intraventricular hemorrhage
a Downgraded one level for risk of bias in some included trials: unclear risk of attrition and reporting bias b Downgraded two levels for serious imprecision of effect estimates (wide 95% CI around estimate consistent with substantial harm or benefit)