To evaluate the effect of opioid analgesics, compared to placebo, no drug, or other non-opioid analgesics or sedatives, on pain, duration of mechanical ventilation, mortality, growth and neurodevelopmental outcomes in newborn infants on mechanical ventilation.
This was a systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources used were Cochrane, MEDLINE, EMBASE and CINAHL databases, and references from review articles. RCTs or quasi-RCTs comparing opioids to a control, or to other analgesics or sedatives in newborn infants on mechanical ventilation were reviewed.
A total of 13 studies on 1505 infants were included. Infants given opioids showed reduced Premature Infant Pain Profile (PIPP) scores compared to the control group (weighted mean difference (WMD) -1.71, 95% CI -3.18 to -0.24). Heterogeneity was significantly high in all analyses of pain. Meta-analyses of mortality, duration of mechanical ventilation and long-term and short-term neurodevelopmental outcomes showed no statistically significant differences. Very preterm infants given morphine took significantly longer to reach full enteral feeding than those in control groups (WMD 2.10 days, 95% CI 0.35 to 3.85). One study that compared morphine with midazolam showed similar pain scores, but fewer adverse effects with morphine.
There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns. Opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators. If sedation is required, morphine is safer than midazolam.
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"For example , the pharmacokinetics/pharmacodynamics of repeated analgesic treatment in the neonate are only beginning to be described (Anand et al., 2008). Less known, however, are the long-term global effects of neonatal analgesia (see American Academy of Pediatrics (Committee on Fetus and Newborn et al., 2000; Anand et al., 2006; Bellu et al., 2010; Fitzgerald and Walker, 2009; Hall et al., 2007) for the need for followup studies). Given the long-term neurological impact of untreated neonatal pain (Fitzgerald and Walker, 2009), it is essential to determine the long-term effects of preemptive analgesia. "
[Show abstract][Hide abstract] ABSTRACT: Use of preemptive analgesia in Neonatal Intensive Care Units is recommended for severe and/or invasive procedures. However, the potential long-term consequences of such analgesia, which may be prolonged, are only beginning to be studied. In this pilot study, a subset of subjects previously enrolled in the Neurological Outcomes and Preemptive Analgesia in Neonates (NEOPAIN) trial was assessed at early childhood. These ex-preterm infants (born at 23-32 weeks of gestational age) required intubation within 72 h postpartum and were randomized to receive either preemptive morphine analgesia (maximum of 14 days) or placebo within 8h post-intubation. At 5-7 years of age, neuropsychological outcomes, morphometrics, adaptive behavior, parent-rated behavior, motivation, and short-term memory were measured. Although overall IQ and academic achievement did not differ between the morphine treated (n=14) and placebo (n=5) groups, preemptive morphine analgesia was associated with distinct differences in other outcome variables. Head circumference of morphine treated children was approximately 7% smaller (Cohen'sd: 2.83, effect size large) and body weight was approximately 4% less (Cohen'sd: 0.81, effect size large); however, height did not differ. In the short-term memory task (delayed matching to sample), morphine treated children exhibited significantly longer choice response latencies than placebo children (3.86±0.33 and 2.71±0.24 s, respectively) (p<0.03) and completed approximately 27% less of the task than placebo children (Cohen'sd: 0.96, effect size large). Parents described morphine treated children as having more social problems, an effect specific to creating and maintaining friendships (Cohen'sd: -0.83, effect size large). Despite the small sample size and the preliminary nature of this study, these results are strongly suggestive of long-lasting effects of preemptive morphine analgesia. A larger investigation with more comprehensive assessments of some of these key features will enable a more complete understanding of the relationship between preemptive morphine treatment and long-term neurocognitive, behavioral, and adaptive outcomes.
Neurotoxicology and Teratology 11/2011; 34(1):47-55. DOI:10.1016/j.ntt.2011.10.008 · 2.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Describes how Drexel University has adopted provisions of a tough new financial reporting law aimed at corporations, with skeptics wondering if such steps are too excessive for colleges. (EV)
[Show abstract][Hide abstract] ABSTRACT: The management of endotracheal tubes and nasal cannulae covers a large part of work time of nurses involved in the care of very preterm infants. These procedures, although continuously performed, have not yet been scientifically demonstrated. In fact, there is limited evidence regarding several points such as the frequency of endotracheal suctioning, the level of suction pressure, the duration of suctioning, the depth of catheter insertion, the sterility, and the use of normal saline during endotracheal suction. With regard to the nasal cannulae, there is a more recent use of this device consisting in delivering end-expiratory pressure or gas flow to reduce the frequency of apneas and desaturations in preterm infants or for the management of RDS. This approach is defined high-flow nasal cannulae (HFNC). In this article, we review the literature on the airway management of intubated patients as well as of infants managed with nasal-CPAP or nasal cannulae. Potential fields of research on this topic are suggested.
Early human development 09/2009; 85(10 Suppl):S85-7. DOI:10.1016/j.earlhumdev.2009.08.024 · 1.79 Impact Factor