**6. Conclusion**

In recent decades, many findings have been published on pain management in the neonatal population, increasingly in preterm neonates, but data are almost lacking for ELBW neonates and the relevant pain profile (postoperative pain) in this population. Except for clonidine, ketamine and chloral hydrate, drug doses have been published for some drugs (morphine, dexmedetomidine and fentanyl), especially in neonates below 37 weeks GA, and for paracetamol and midazolam in preterm neonates less than 32 weeks of PMA and GA respectively while insufficient data are available for fentanyl derivatives (sufentanil) in preterm neonates and especially in ELBW neonates. This period of life has specific pharmacological challenges due to extreme immaturity and unpredictable drug efficacy and safety, so any contribution of knowledge and established drug databases to optimize pain management in extremely low birth weight neonates using a multimodal approach to pain management is essential.
