Background and objectives We retrospectively compared short-term and neurodevelopmental outcome of very low birth weight infants (VLBWI) before (n = 84) and after implementation (n = 69) of a protocol for the management of neonatal pain and sedation.

Methods Opiate exposure, time on mechanical ventilation, inotropic support, details on nutritional aspects, and growth were compared between baseline and after protocol implementation. Infants were evaluated at 12 months corrected age using standardised neurologic examination and Bayley Scales of Infant Development-II.

Results Cumulative mean ± SD opiate dose (baseline dose of 14 ± 39 mg/kg vs. intervention group dose of 84 ± 222 mg/kg morphine equivalents; p < 0. 0001) increased after implementation. Time on mechanical ventilation, inotropic support, time on parenteral nutrition, growth, and length of stay were similar before and after implementation. There were no differences in neurodevelopmental outcome variables before and after intervention (MDI: 85 ± 14 vs. 84 ± 16, p = 0.6; PDI: 87 ± 19 vs. 83 ± 19, p = 0.2; BRS: 74 ± 27 vs. 68 ± 32, p = 0.2). Multiple linear regression analysis identified opiate exposure as a possible risk factor for lower MDI (estimate = -0.15; p = 0.004) and Behaviour Rating Scale (BRS) scores (estimate = -0.39; p = 0.012).

Conclusions Implementation of a neonatal pain and sedation protocol results in an increase in opiate prescription without affecting short-term outcome and neurodevelopmental performance of VLBWI at 12 months corrected age.