Pharmacology of Common Analgesic and Sedative Drugs Used in the Neonatal Intensive Care Unit

Donato, Jamesia; Rao, Karishma; Lewis, Tamorah

doi:10.1016/j.clp.2019.08.004

Cited by 32 publications

(42 citation statements)

References 93 publications

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“…Due to the specificity of this group of infants, their postoperative compliance is poor. In such infants, sedatives and thoracic casts have been the most commonly used interventions in the past to limit the infant's voluntary movements in bed [ 15 , 16 ]. From April 2015 to July 2018, 30 infants with severed fingers were replanted.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children

Chen¹,

Wang²,

Wang³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children’s anxiety, so as to reduce the occurrence of vascular crisis. Methods. The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time. Results. Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant ( P < 0.05 ). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups ( P > 0.05 ). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant ( P < 0.05 ). Conclusion. For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children’s postoperative crying and is conducive to children’s postoperative recovery.

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Section: Introductionmentioning

confidence: 99%

Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children

Chen¹,

Wang²,

Wang³

et al. 2022

Computational and Mathematical Methods in Medicine

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“…13 Particularly in neonates and preterm infants, opioids may reach high serum concentrations that induce the risk of toxicity and dependency. 14 These risks are enhanced by the reduced hepatic and renal metabolism of drugs in newborns compared with older children or adults, leading to slower elimination and subsequently a longer half-life of opioids seen in this age group. 15 Acute critical illness and any chronic co-morbidities also may contribute to the presence of hepatic and renal impairment and therefore exacerbate the prolonged presence of opioids and their related complications in neonates due to reduced clearance of these agents.…”

Section: Pathogenesismentioning

confidence: 99%

“…15 Acute critical illness and any chronic co-morbidities also may contribute to the presence of hepatic and renal impairment and therefore exacerbate the prolonged presence of opioids and their related complications in neonates due to reduced clearance of these agents. 14 Another drug class that is frequently prescribed to critically ill newborn patients are benzodiazepines such as midazolam, lorazepam, and diazepam whose main goal is provision of required sedation. 16 Although their molecular mechanisms are still not completely understood, it is well accepted that benzodiazepines interact with the gamma amino butyric acid (GABA)-A receptor.…”

Section: Pathogenesismentioning

confidence: 99%

“…org Benzodiazepine pharmacokinetics, in neonates and preterm infants, are similar to that of opioids where immature hepatic and renal pathways lead to reduced elimination rates and subsequently longer drug half-lifes. 14 Interestingly, midazolam has been noted by some authors to have great variability of drug clearance based on gestational age with higher midazolam clearance in neonates born after 39 weeks of gestation. 14,19 Assessment A precise diagnosis of IWS may be very difficult to make since patients are usually in an intensive care setting, where many of their symptoms can be misinterpreted due to their overlap with other conditions and interventions.…”

Section: Pathogenesismentioning

confidence: 99%

“…14 Interestingly, midazolam has been noted by some authors to have great variability of drug clearance based on gestational age with higher midazolam clearance in neonates born after 39 weeks of gestation. 14,19 Assessment A precise diagnosis of IWS may be very difficult to make since patients are usually in an intensive care setting, where many of their symptoms can be misinterpreted due to their overlap with other conditions and interventions. 7,8 In addition, newborns in the NICU may be submitted to more than one drug that may cause withdrawal symptoms.…”

Section: Pathogenesismentioning

confidence: 99%

See 2 more Smart Citations

Iatrogenic Withdrawal Syndrome in Critically Ill Neonates: A Review of Mechanisms, Assessment, Management, and Prevention

Santos

Peano

Soares

et al. 2022

J Pediatr Intensive Care

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Considering that neonatal pain is a relevant matter given its implications and consequences, many neonates, particularly those undergoing critical care, are subjected to analgo-sedation therapies, which commonly includes treatment with opioids and benzodiazepines. These drugs, however, can induce tolerance and dependency, leading to the development of the so-called iatrogenic withdrawal syndrome (IWS) which is observed following discontinuation of these therapeutic agents particularly when utilized for a prolonged period of time (≥5 days). IWS consists of signs and symptoms manifested especially in young children, such as term and premature newborns in the neonatal intensive care unit, who are less capable of metabolizing and eliminating these drugs, compared with older patients. In this study, we review assessment tools that were developed to identify, evaluate, and manage children affected by IWS. The studies reviewed demonstrate that optimal management of IWS includes consideration of alternate routes of drug administration, the need for adequate time for drug tapering, and also the presence of planned rescue therapy when encountering cases refractory to ongoing management. Equally important is prevention of IWS which can be accomplished with the implementation of drug rotation protocols and, adherence to evidenced-based guidelines which facilitate an overall decline in the use and duration of opioids and benzodiazepines. Finally, our review strongly supports the need for more research on IWS in neonates given their increased susceptibility and sparse published data for this age group.

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Use of Dexmedetomidine and Opioids in Hospitalized Preterm Infants

Curtis,

Kilpatrick,

Billimoria

et al. 2023

JAMA Netw Open

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ImportanceDexmedetomidine, an α2-adrenergic agonist, is not approved by the Food and Drug Administration for use in premature infants. However, the off-label use of dexmedetomidine in premature infants has increased 50-fold in the past decade. Currently, there are no large studies characterizing dexmedetomidine use in US neonatal intensive care units (NICUs) or comparing the use of dexmedetomidine vs opioids in infants.ObjectivesTo describe dexmedetomidine use patterns in the NICU and examine the association between dexmedetomidine and opioid use in premature infants.Design, Setting, and ParticipantsA multicenter, observational cohort study was conducted from November 11, 2022, to April 4, 2023. Participants were inborn infants born between 22 weeks, 0 days, and 36 weeks, 6 days, of gestation at 1 of 383 Pediatrix Medical Group NICUs across the US between calendar years 2010 and 2020.Main Outcome and MeasureExposure to medications of interest defined as total days of exposure, timing of use, and changes over time.ResultsA total of 395 122 infants were included in the analysis. Median gestational age was 34 (IQR, 32-35) weeks, and median birth weight was 2040 (IQR, 1606-2440) g. There were 384 infants (0.1% of total; 58.9% male) who received dexmedetomidine. Infants who received dexmedetomidine were born more immature, had lower birth weight, longer length of hospitalization, more opioid exposure, and more days of mechanical ventilation. Dexmedetomidine use increased from 0.003% in 2010 to 0.185% in 2020 (P &lt; .001 for trend), while overall opioid exposure decreased from 8.5% in 2010 to 7.2% in 2020 (P &lt; .001 for trend). The median postmenstrual age at first dexmedetomidine exposure was 31 (IQR, 27-36) weeks, and the median postnatal age at first dexmedetomidine exposure was 3 (IQR, 1-35) days. The median duration of dexmedetomidine receipt was 6 (IQR, 2-14) days.Conclusion and RelevanceThe findings of this multicenter cohort study of premature infants suggest that dexmedetomidine use increased significantly between 2010 and 2020, while overall opioid exposure decreased. Future studies are required to further examine the short- and long-term effects of dexmedetomidine in premature and critically ill infants.

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Pharmacology of Common Analgesic and Sedative Drugs Used in the Neonatal Intensive Care Unit

Cited by 32 publications

References 93 publications

Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children

Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children

Iatrogenic Withdrawal Syndrome in Critically Ill Neonates: A Review of Mechanisms, Assessment, Management, and Prevention

Use of Dexmedetomidine and Opioids in Hospitalized Preterm Infants

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