• Gina Ancora, Paola Lago, Elisabetta Garetti, Daniele Merazzi, Patrizia Savant Levet, Carlo Valerio Bellieni, Luisa Pieragostini, and Anna Pirelli.
• NICU, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy.
• Acta Paediatr. 2019 Feb 1; 108 (2): 208-217.

AimThis review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants.MethodsWe reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotracheal intubation in newborn infants admitted to neonatal intensive care units. The subsequent guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsOur review produced five strong standard of care recommendations. One, reduce neonatal stress and use nonpharmacological analgesia during invasive ventilation. Two, favour intermittent boluses of opioids, administered after pain scores and before invasive procedures, during short expected periods of mechanical ventilation, mainly in preterm infants affected by respiratory distress syndrome. Three, do not use morphine infusion in preterm infants under 27 gestational weeks. Four, always use algometric scores to titrate analgesic drugs doses. Five, use premedication before endotracheal intubation for a more rapid, less painful, less traumatic and safer manoeuvre. We also developed 30 conditional recommendations on therapeutic options.ConclusionOur review produced 35 recommendations on standard care and therapeutic options relating to the analgesia and sedation of newborn infants during ventilation and before endotracheal intubation.©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

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