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The use of opioids in neonates. A retrospective study of 933 cases
G Purcell-Jones1, F Dormon, E Sumner
1Department of Anaesthesia, Hospital for Sick Children, London.
Insights
Postoperative opioid use in neonates increased significantly over five years. Opioid administration, particularly during low medical staffing hours, was linked to respiratory depression and failure in vulnerable infants.
Area of Science:
- Neonatal surgery
- Pediatric intensive care
- Pharmacology
Background:
- Neonatal intensive care units (NICUs) manage critically ill infants requiring advanced interventions.
- Postoperative pain management in neonates is crucial but challenging due to physiological immaturity.
Purpose of the Study:
- To analyze trends in postoperative opioid use in neonates admitted to a surgical intensive care unit.
- To assess the incidence and potential adverse effects of opioid administration in this population.
Main Methods:
- Retrospective study design.
- Data collection from a surgical intensive care unit over a 5-year period (1980-1984).
- Analysis of opioid administration records and patient outcomes.
Main Results:
- Opioid use increased from 9.7% to 27.2% of admitted neonates.
- 88 out of 240 neonates (36.6%) requiring ventilation received opioids.
- Four neonates on ventilation experienced opioid-induced respiratory depression, hindering weaning.
- Seven out of 51 spontaneously breathing neonates (13.7%) receiving opioids developed apnea or respiratory failure.
- Opioid administration peaked during late evening and early morning hours with reduced medical supervision.
Conclusions:
- Postoperative opioid administration in neonates is associated with significant risks, including respiratory depression and failure.
- The timing of opioid administration may correlate with periods of lower medical staffing, increasing potential risks.
- Further research into safer neonatal pain management strategies is warranted.
Abstract:
This is a retrospective study on the use of postoperative opioids in neonates admitted to the surgical intensive care unit at Great Ormond Street over a 5-year period (1980-84). A total of 131 (14%) babies received opioids out of 933 neonates admitted to the unit. The use of opioids increased from 9.7% to 27.2% of admitted cases during the survey period. Postoperative ventilation of the lungs was necessary in 240 (25.7%) cases and 88 (36.6%) of these were given opioids. Four babies initially failed to wean from controlled ventilation as a result of opioid induced respiratory depression. A total of 51 (7.35%) spontaneously breathing neonates received opioids and seven (13.7%) of these developed apnoea or respiratory failure thought to be induced by opioids. The administration of opioids by nurses occurred most frequently in the late evening and early hours of the morning, when medical cover is at its lowest level.