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Published on: February 28, 2025
Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis
R Bellù1, Koert de Waal, R Zanini
1Neonatal Intensive Care Unit, Alessandro Manzoni Hospital, Lecco, Italy. r.bellu@ospedale.lecco.it
Summary
Opioid analgesics may reduce pain scores in newborn infants on mechanical ventilation but do not significantly impact mortality or neurodevelopmental outcomes. Routine use is not recommended; selective use based on pain indicators is advised, with morphine being safer than midazolam for sedation.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Critical Care
Background:
- Newborn infants on mechanical ventilation often require analgesia and sedation.
- The use of opioid analgesics in this population is common but requires careful evaluation of risks and benefits.
Purpose of the Study:
- To systematically review and meta-analyze the effects of opioid analgesics versus control or other sedatives on pain, ventilation duration, mortality, and neurodevelopmental outcomes in mechanically ventilated newborns.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Cochrane, MEDLINE, EMBASE, and CINAHL databases.
- Included 13 RCTs involving 1505 infants.
Main Results:
- Opioids reduced Premature Infant Pain Profile (PIPP) scores (WMD -1.71).
- No significant differences were found in mortality, duration of mechanical ventilation, or neurodevelopmental outcomes.
- Morphine use was associated with a longer time to full enteral feeding in very preterm infants (WMD 2.10 days).
- Morphine showed similar pain scores but fewer adverse effects than midazolam.
Conclusions:
- Insufficient evidence supports routine opioid use in mechanically ventilated newborns.
- Opioids should be used selectively based on clinical judgment and pain assessment.
- Morphine is a safer option than midazolam for sedation in this population.
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