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Opioid withdrawal in critically ill neonates.
Karen D Dominguez1, Dawn M Lomako, Robert W Katz
1College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. kdominguez@salud.unm.edu
The Annals of Pharmacotherapy
|March 28, 2003
Summary
Opioid withdrawal is common in critically ill neonates receiving fentanyl infusions. Higher doses and longer durations of fentanyl increase the risk of neonatal abstinence syndrome.
Area of Science:
- Neonatal intensive care
- Pharmacology
- Clinical research
Background:
- Critically ill neonates often require continuous opioid infusions for pain and sedation.
- Fentanyl is a commonly used opioid in neonatal intensive care units (NICUs).
- Neonatal Abstinence Syndrome (NAS) is a concern with prolonged opioid exposure.
Purpose of the Study:
- To determine the incidence of opioid withdrawal in neonates receiving continuous fentanyl infusions.
- To identify risk factors associated with fentanyl-induced opioid withdrawal in this population.
Main Methods:
- Prospective interventional cohort study in a university hospital NICU.
- 19 neonates receiving continuous fentanyl infusions for at least 24 hours were enrolled.
- Neonatal Abstinence Scoring System (Finnegan scale) was used to assess withdrawal symptoms.
Main Results:
- Opioid withdrawal occurred in 53% of neonates (10 out of 19).
- Higher total fentanyl dose (median 525 vs. 168 µg/kg) and longer infusion duration (median 10 vs. 7 days) were significantly associated with withdrawal.
- Fentanyl dose ≥415 µg/kg and duration ≥8 days predicted withdrawal with high sensitivity and specificity.
Conclusions:
- Continuous fentanyl infusions are frequently associated with opioid withdrawal in critically ill neonates.
- Prolonged duration and higher total dosage of fentanyl are significant risk factors for neonatal abstinence syndrome.