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Resolution of opioid-induced postoperative ileus in a newborn infant after methylnaltrexone

Lars Garten1, Petra Degenhardt, Christoph Bührer

  • 1Department of Neonatology, Charité University Medical Center, Berlin, Germany. lars.garten@charite.de

Journal of Pediatric Surgery
|March 8, 2011
PubMed

Insights

Methylnaltrexone effectively treated postoperative ileus in a neonate receiving opioid analgesia. This peripheral-acting μ-opioid receptor antagonist rapidly resolved intestinal dysmotility without causing pain or withdrawal symptoms.

Area of Science:

  • Neonatal care
  • Pharmacology
  • Gastroenterology

Background:

  • Opioid analgesia is frequently used in neonates but can cause significant gastrointestinal side effects, such as ileus.
  • Methylnaltrexone, a peripherally acting μ-opioid receptor antagonist, has shown efficacy in adults for opioid-induced constipation and postoperative ileus.

Observation:

  • A newborn infant experienced severe, prolonged postoperative ileus despite fentanyl analgesia following major abdominal surgery.
  • Bowel function remained quiescent for 8 days, indicating significant intestinal dysmotility.

Findings:

  • Intravenous administration of methylnaltrexone (0.15 mg/kg) resulted in rapid resolution of intestinal dysmotility within 15 minutes.
  • Daily methylnaltrexone treatments were continued until fentanyl analgesia was discontinued.
  • No adverse effects, including pain or opioid withdrawal, were observed during methylnaltrexone treatment.

Implications:

  • Methylnaltrexone represents a potential therapeutic option for managing opioid-induced gastrointestinal dysmotility in neonates.
  • This case suggests methylnaltrexone can safely and effectively reverse ileus in critically ill newborns undergoing surgery and receiving opioid therapy.
  • Further research is warranted to establish optimal dosing and long-term safety of methylnaltrexone in the neonatal population.

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