Neonatal / Paediatric

Paediatric and neonatal surgery presents some of the most demanding challenges in perioperative medicine. Surgical neonates — those within the first 28 days of life — are among the most physiologically vulnerable patients in any hospital, requiring highly specialised care that spans multiple disciplines, from paediatric surgery and anaesthesia to neonatology and nursing. Untreated or inadequately managed pain in this population carries both short- and long-term negative consequences, and surgical neonates face particular risk due to repeated noxious exposures from surgery and the procedures that accompany postoperative care.

While ERAS® Society guidelines have long integrated evidence-based practices into multimodal care pathways that have improved outcomes across multiple adult surgical specialties, paediatric ERAS studies have historically been limited, and dedicated ERAS® Society guidelines for this population did not exist until recently. Recognising this gap, the ERAS® Society has made the development of paediatric and neonatal guidelines a priority, establishing a programme of work specifically designed to translate the principles of enhanced recovery into the unique context of children’s surgery.

A key feature of neonatal perioperative care is that, despite the wide variety of surgical pathology encountered, neonates share many perioperative priorities — allowing for the development of unit-wide, evidence-based ERAS recommendations applicable across surgical procedures within the neonatal intensive care unit (NICU). The ERAS® Society has published guidelines covering neonatal perioperative care and neonatal intestinal resection surgery, as well as dedicated consensus recommendations on both pharmacological and non-pharmacological pain management in this population. The non-pharmacological pain management recommendations — developed through systematic review and modified Delphi consensus — include the use of sweet-tasting solutions, non-nutritive sucking, skin-to-skin contact, and music therapy, with the aim of reducing neonatal opioid usage alongside pharmacological therapies.

These guidelines provide a foundation for ongoing ERAS guideline development in paediatric surgery and have the potential to lead to improved perioperative care across a broad range of paediatric surgical specialties. The ERAS® Society remains committed to expanding this evidence base, ensuring that the youngest and most vulnerable surgical patients benefit from the same structured, multidisciplinary approach to care that has transformed outcomes in adult surgery.