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Related Experiment Videos

Opioids for newborn infants receiving mechanical ventilation.

Roberto Bellù1, Olga Romantsik2, Chiara Nava1

  • 1Neonatal Intensive Care Unit, Ospedale "A. Manzoni", Lecco, Italy.

The Cochrane Database of Systematic Reviews
|March 17, 2021
PubMed
Summary

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Opioid analgesics likely offer little to no benefit in reducing mechanical ventilation duration or neonatal mortality for newborns. Evidence on pain and neurodevelopmental outcomes remains uncertain, suggesting selective use based on clinical judgment.

Area of Science:

  • Neonatal intensive care
  • Pain management in newborns
  • Pharmacological interventions

Background:

  • Mechanical ventilation is a common, yet painful, procedure for newborns in intensive care.
  • Infant pain sensitivity can negatively impact clinical and neurodevelopmental outcomes.
  • Effective pain management is crucial for improving survival and long-term health in neonates.

Purpose of the Study:

  • To evaluate the benefits and harms of opioid analgesics in neonates undergoing mechanical ventilation.
  • To compare opioid use against placebo, other opioids, or other sedatives/analgesics.
  • To assess the impact of opioids on pain, ventilation duration, mortality, and neurodevelopmental outcomes.

Main Methods:

  • Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.

Related Experiment Videos

  • Searched major databases including Cochrane Neonatal, MEDLINE, Embase, and CINAHL.
  • Included term and preterm infants receiving mechanical ventilation; data extraction and risk of bias assessment followed Cochrane EPOC criteria.

    • Main Results:

    • Twenty-three studies (2023 infants) were included; 15 compared morphine/fentanyl to placebo.
    • Opioids showed uncertain effects on pain scores (PIPP) and neurodevelopmental outcomes.
    • Morphine/fentanyl likely have little to no effect on reducing ventilation duration or neonatal mortality (moderate certainty evidence).

    Conclusions:

    • Current evidence is insufficient to support routine opioid use for pain management in ventilated neonates.
    • Opioids may have little to no effect on key clinical outcomes like ventilation duration and mortality.
    • Selective use of opioids, guided by clinical judgment and pain indicators, is recommended due to limited evidence and measurement challenges.