Canadian neonatologist practices regarding opioid use in ventilated and spontaneously breathing infants undergoing medical procedures

Opioids are indicated for the management of procedural pain in neonates. There are limited data describing factors influencing patterns of use.

We conducted an online English survey of Canadian neonatologists using Survey Monkey, whereby they answered questions about the frequency and pattern of use of opioids, and specifically, of morphine and fentanyl, for ventilated and spontaneously breathing infants undergoing selected painful medical procedures.

Hundred and twenty nine of 225 (57%) eligible neonatologists participated. They reported that opioids were part of their practice for managing procedural pain in 100% of ventilated infants and 93% of spontaneously breathing infants. Frequency of opioid use was associated with infant ventilation status: spontaneously breathing infants were 28% less likely to receive them (P=0.013). For morphine, the most commonly used dose was 100 microg/kg in ventilated infants and 50 microg/kg in spontaneously breathing infants. For fentanyl, 1 microg/kg was the most frequently used dose in both infant populations. Use of morphine and fentanyl were significantly associated with 2-way interactions (P<0.0001) between infant ventilation status, gestational age, and opioid dose. Eighty-two percent of respondents cited respiratory depression as a concern for spontaneously breathing infants compared with 31% for ventilated infants (P<0.0001).

Neonatologists frequently report using opioids to manage procedural pain, however, spontaneously breathing infants are less likely to receive them, and their use varies according to infant and procedure characteristics. These data point to the need to further investigate, in a more controlled design, the pharmacologic effects of opioids in this population to better guide clinicians about their optimal use.