Fentanyl Exposure in Preterm Infants: Five-Year Neurodevelopmental and Socioemotional Assessment

Mills, Kimberly P.; Lean, Rachel E.; Smyser, Christopher D.; Inder, Terrie E.; Rogers, Cynthia; McPherson, Christopher

doi:10.3389/fpain.2022.836705

Cited by 6 publications

(3 citation statements)

References 58 publications

(72 reference statements)

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“…Thus no definite conclusion could be reached concerning the potential effect of opioids, in general, or fentanyl per se, on blood pressure in preterm and term infants [90,103]. A longterm study of infants treated with fentanyl early after birth did not find any significant correlation between cumulative fentanyl exposure and neurodevelopmental outcomes at five years of age [107]. These results were consisted with previous reports in VLBWI at the age of two years [108].…”

Section: Fentanylcontrasting

confidence: 55%

Antibiotic Analgesic-Sedative and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review

Kontou,

Agakidou,

Chatziioannidis

et al. 2024

Preprint

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Several studies have shown that antibiotics, analgesic – sedative, and antiseizure medications are among the most commonly used medications in preterm and sick neonates. These infants are at high risk of developing nosocomial infections, central nervous system complications, and are exposed to numerous painful/stressful procedures. These severe, potentially life-threatening complications may have serious short- and long-term consequences and should be prevented and/or promptly treated. Previous studies and reviews have revealed significant variability in medications used in neonatal intensive care units (NICUs) worldwide, especially concerning the indications and dosages of first-line medications. This variability indicates the lack of adequate studies regarding the effectiveness and safety of these medications in neonates, especially the preterm ones. Important obstacles contributing to inadequate studies in preterm infants include difficulties in obtaining parental consent, physicians’ unwillingness to recruit preterm infants, the lack of license for use in neonates, and other scientific and ethical concerns. This review is an update on the use of antimicrobials – antifungals, analgesics – sedatives, and antiseizure medications used in neonates, focusing on existing evidence or knowledge gaps regarding their pharmacokinetics, indications, safety, dosage regimen (dose, dosing interval, route of administration), and evidence-based guidelines for the optimal use in neonates.

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Section: Fentanylcontrasting

confidence: 55%

Antibiotic Analgesic-Sedative and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review

Kontou,

Agakidou,

Chatziioannidis

et al. 2024

Preprint

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“…The first report of a cohort of very preterm neonates (23-30 gestational age) evaluated the association between cumulative neonatal exposure to fentanyl by neurodevelopmental and socioemotional outcomes in children at 5 years of age. However, according to the authors, the conclusions of this study were still ambiguous [38]. Dosing: analgesia [39], intermittent slow IV push 0.0005-0.003 mg/kg/dose, continuous infusion 0.0005-0.002 mg/kg/hour; sedation, slow IV push 0.001-0.004 mg/kg/dose may be repeated every 2-4 hours, continuous analgesia/sedation initial 0.001-0.002 mg/kg then 0.0005-0.001 mg/kg/hour.…”

Section: Fentanylmentioning

confidence: 75%

Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

Jancova,

Pokorna

2023

Topics in Postoperative Pain

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Limited data are available in the literature on multimodal pain management in extremely low birth weight (ELBW) neonates. This chapter aimed to summarize current knowledge about the effects of analgesics and sedatives (paracetamol, opioids, benzodiazepines and anaesthetics) on postoperative pain management (≤ 48 hours after surgery). The primary endpoints of postoperative pain management were searched using validated pain assessment instruments, such as pain intensity, excessive sedation, drug consumption or adequate rescue medication. The secondary endpoints are the safety parameters of the drugs used, while the determinants of short/long-term outcome (duration of mechanical ventilation, intraventricular haemorrhage—IVH, periventricular leukomalacia—PVL, postnatal growth restriction, stage of chronic lung disease—CLD or neurodevelopmental outcome according to the Bayley-II Scale of Infant Development at 18–24 months or developmental equivalents at early-school age) were assessed as tertiary endpoints. Additionally, one of the most important key elements of clinical science is known as clinical research study validation, including specific tools and techniques within the validation processes. This chapter focuses on postoperative multimodal pain management, including the implementation of pain assessment tools and analgesic and sedative dosing regimens needed to achieve the efficacy and safety goals of an optimal pain profile in ELBW neonates; only proven non-pharmacological procedures are not included.

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“…Some studies have recently demonstrated adverse long-tern neurodevelopmental effects [ 32 ] whereas others demonstrated that low dose infusion did not affect [ 18 , 33 ]. These long-term effect do not occur with fentanyl [ 34 ]. Regarding mechanical ventilation, it is preferable not to do it routinely, but only in selected patients [ 18 ].…”

Section: Management Of Painmentioning

confidence: 99%

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology

et al. 2023

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Infants might be exposed to pain during their admissions in the neonatal intensive care unit [NICU], both from their underlying conditions and several invasive procedures required during their stay. Considering the particularities of this population, recognition and adequate management of pain continues to be a challenge for neonatologists and investigators. Diverse therapies are available for treatment, including non-pharmacological pain management measures and pharmacological agents (sucrose, opioids, midazolam, acetaminophen, topical agents…) and research continues. In recent years one of the most promising drugs for analgesia has been dexmedetomidine, an alpha-2 adrenergic receptor agonist. It has shown a promising efficacy and safety profile as it produces anxiolysis, sedation and analgesia without respiratory depression. Moreover, studies have shown a neuroprotective role in animal models which could be beneficial to neonatal population, especially in preterm newborns. Side effects of this therapy are mainly cardiovascular, but in most studies published, those were not severe and did not require specific therapeutic measures for their resolution. The main objective of this article is to summarize the existing literature on neonatal pain management strategies available and review the efficacy of dexmedetomidine as a new therapy with increasing use in the NICU.

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Fentanyl Exposure in Preterm Infants: Five-Year Neurodevelopmental and Socioemotional Assessment

Cited by 6 publications

References 58 publications

Antibiotic Analgesic-Sedative and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review

Antibiotic Analgesic-Sedative and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review

Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology

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