Seizure and Electroencephalographic Changes in the Newborn Period Induced By Opiates and Corrected By Naloxone Infusion

Abstract

OBJECTIVE:To describe the association between opioid administration in the newborn period and neurologic abnormalities STUDY DESIGN:Case reports of two infants who presented with seizure activity and abnormal electroencephalograms associated with opiate administration, and reversed by naloxone RESULTS:The first was a preterm infant who developed a burst-suppression pattern on the electroencephalogram while receiving a continuous infusion of morphine and muscle paralysis. Naloxone injection during the electroencephalogram recording reversed the burst-suppression pattern. The second was a term infant receiving fentanyl infusion for pain control following surgery, who presented with motor seizure that was only partially controlled with barbiturates. An abnormal electroencephalogram recording during the opiate infusion improved with naloxone administration. CONCLUSION:Our observations indicate a potential for neurologic abnormalities, including induction of seizure activity and electroencephalogram abnormalities, suggesting caution when opiates are used for sedation and/or pain control in the newborn period.Opiates are widely used in neonatal intensive care units for routine sedation/analgesia of critically ill neonates receiving mechanical ventilation, as well as for postoperative pain control. 1 Seizure activity as a complication of opioid administration has been reported in the literature in laboratory animals, 2 adult humans 3-5 and neonates. 6 Electrical seizure activity induced by opiates has been well documented with electroencephalogram (EEG) recording in animals. 2 The correlation between abnormal movements and electrical seizures is less consistent in adult humans receiving opiates 5,7-9 and is lacking in the neonatal patient. The objective of our study is to report on two infants with abnormal electroencephalographic findings while receiving opioids. One infant presented with clinical and electroencephalographic seizure activity. The second infant had a grossly abnormal EEG pattern. CASE 1Baby girl M was born at 39 weeks' gestation by elective cesarean section to a 34-year-old mother. The birth weight was 3975 gm, the cord arterial pH was 7.34, and the Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. The baby was admitted to the normal newborn nursery for routine care. She was transferred to the neonatal intensive care unit (NICU) at 24 hours of age due to abdominal distention and bilious vomiting. Radiologic studies revealed a small bowel obstruction and she was operated at 35 hours of age for congenital ileal atresia. She received a cumulative dose of 20 g (5 g/kg) of fentanyl for anesthesia and 1 mg (0.25 mg/kg) of morphine in the operating suite for pain control (increased heart rate and increased blood pressure during operation). There were no complications during the surgery. Fifteen minutes postoperatively she was noted to have abnormal movements (fasciculation of the tongue and lips). A continuous infusion of fentanyl was started at a rate of 5 g/kg per hour beginning 30 minutes postsur...

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