Ten Barge Judith A, van den Bosch Gerbrich E, Slater Rebeccah, van den Hoogen Nynke J, Reiss Irwin K M, Simons Sinno H P
Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatrics, University of Oxford, Oxford, UK.
Paediatr Drugs. 2025 Mar;27(2):201-220. doi: 10.1007/s40272-024-00676-0. Epub 2025 Jan 3.
Necrotizing enterocolitis (NEC) is a relatively rare but very severe gastrointestinal disease primarily affecting very preterm infants. NEC is characterized by excessive inflammation and ischemia in the intestines, and is associated with prolonged, severe visceral pain. Despite its recognition as a highly painful disease, current pain management for NEC is often inadequate, and research on optimal analgesic therapy for these patients is lacking. Insight into the mechanisms underlying intestinal pain in infants with NEC-visceral pain-could help identify the most effective analgesics for these vulnerable patients. Therefore, this comprehensive review aims to provide an overview of visceral nociception, including transduction, transmission, modulation, and experience, and discuss the implications for analgesic therapy in preterm infants with NEC. The transmission of visceral pain differs from that of somatic pain, contributing to the diffuse nature of visceral pain. Studies evaluating the effectiveness of analgesics for treating visceral pain in infants are scarce. However, research in visceral pain models highlights agents that may be particularly effective for treating visceral pain based on their mechanisms of action. Further research is necessary to determine whether agents that have shown promise for treating visceral pain in preclinical studies and adults are effective in infants with NEC as well.
坏死性小肠结肠炎（NEC）是一种相对罕见但非常严重的胃肠道疾病，主要影响极早产儿。NEC的特征是肠道过度炎症和缺血，并伴有长期、严重的内脏疼痛。尽管它被认为是一种疼痛剧烈的疾病，但目前针对NEC的疼痛管理往往不足，且缺乏针对这些患者的最佳镇痛治疗研究。深入了解NEC婴儿肠道疼痛（内脏疼痛）的潜在机制，有助于为这些脆弱患者确定最有效的镇痛药。因此，本综述旨在概述内脏伤害感受，包括转导、传递、调制和体验，并讨论对NEC早产儿镇痛治疗的意义。内脏痛的传递与躯体痛不同，这导致了内脏痛的弥漫性。评估镇痛药治疗婴儿内脏痛有效性的研究很少。然而，在内脏痛模型中的研究突出了基于其作用机制可能对治疗内脏痛特别有效的药物。还需要进一步研究，以确定在临床前研究和成人中显示出治疗内脏痛前景的药物对NEC婴儿是否也有效。
