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Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long-Term Neurodevelopment
R M Schiller1, K Allegaert1, Maayke Hunfeld1
1Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Insights
Managing pain and stress in infants is crucial, but analgosedative drugs may pose risks to neurodevelopment. A balanced approach is needed to optimize their use in neonatal and pediatric intensive care units.
Area of Science:
- Neonatalogy
- Pediatric Intensive Care
- Neurodevelopmental Pharmacology
Background:
- Inadequate pain and stress management in infants increases morbidity and mortality.
- Analgosedative exposure in infancy may lead to neurodevelopmental impairment, as suggested by animal studies.
- Neonatal and pediatric intensive care unit (NICU/PICU) survivors may have prolonged exposure to these drugs.
Purpose of the Study:
- To review the optimal dosing of commonly used analgosedative medications.
- To evaluate the potential long-term effects of analgosedatives on the developing human brain.
- To assess the impact on neuropsychological functioning in infants.
Main Methods:
- Literature review of analgosedative use in neonatal and pediatric intensive care.
- Analysis of studies on drug effects on infant neurodevelopment.
- Examination of optimal dose determination strategies.
Main Results:
- Optimal dosing strategies for analgosedatives are critical.
- Potential risks of analgosedatives to infant neurodevelopment require careful consideration.
- A balanced approach is necessary to weigh benefits against side effects.
Conclusions:
- Balancing the benefits of pain and stress relief with potential neurodevelopmental risks is essential.
- Further research is needed to understand long-term effects in humans.
- Individualized assessment of analgosedative use in vulnerable infant populations is recommended.
Abstract:
Inadequate pain and/or stress management in preterm- and term-born infants has been associated with increased morbidity and even mortality. However, exposure to analgosedatives during early infancy may also be one of the risk factors for subsequent neurodevelopmental impairment, at least in animal studies. Because infants admitted to neonatal or pediatric intensive care units may receive high amounts of these drugs for prolonged periods of time and the majority of these infants nowadays survive to discharge, this is of major concern. A balanced approach that incorporates the assessment and quantification of both wanted effects as well as unwanted side effects is therefore needed. In this article, the optimal dose determination of commonly used analgosedative drugs as well as their potential long-term effects on the developing human brain and neuropsychological functioning are reviewed.
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