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Published on: November 14, 2018
Intranasal Analgosedation for Infants in the Neonatal Intensive Care Unit: A Systematic Review
Diane Snyers1, Sophie Tribolet1, Vincent Rigo1
1Neonatology Division, CHU de Liège, Liège, Belgium.
Insights
Intranasal medications show promise for pain relief and sedation in newborns during procedures. While effective, further research is needed to confirm safety and optimize drug choices for neonatal intensive care units.
Area of Science:
- Neonatal intensive care
- Pediatric pain management
- Pharmacology
Background:
- Effective pain management is crucial for neonates.
- Intranasal analgesia and sedation are established in children but understudied in infants.
- This review assesses intranasal medication use in neonatal intensive care units (NICUs).
Approach:
- Systematic review of clinical studies.
- Searched MEDLINE, Scopus, Embase, and Cochrane Library.
- Included seven studies with 401 neonates.
Key Points:
- Various agents (midazolam, fentanyl, ketamine, dexmedetomidine) used for procedures like intubation and MRI.
- All studies showed significant reductions in pain and sedation markers.
- Adverse effects were rare, including desaturation and apnea, possibly molecule-related.
Conclusions:
- Intranasal route is a viable option for neonatal procedural pain and sedation, especially with difficult IV access.
- Limited safety data necessitates further investigation.
- Optimal drug regimens require characterization before widespread NICU adoption.
Aim:
Pain management is important for newborns' immediate and long-term well-being. While intranasal analgesia and sedation have been well studied in children, their use could be extended to term and preterm infants. This systematic review aims to assess the use of intranasal medications for procedural analgesia or sedation in the neonatal intensive care unit.
Methods:
MEDLINE via Ovid, Scopus, Embase, and Cochrane Library were searched independently by two reviewers for clinical studies on sedation or analgesia given intranasally.
Results:
Seven studies, with 401 patients, were included. The studies described various molecules (midazolam, fentanyl, ketamine, or dexmedetomidine) for different procedures such as intubation in the delivery room, screening for retinopathy, or magnetic resonance imaging. All studies reported significant reduction in pain and sedation markers (based on clinical scales, skin conductance, and clinical variables such as heart rate and crying time). Adverse effects were uncommon and mostly consisted in desaturation, apnoea, hypotension, or paradoxical reactions.
Discussion And Conclusion:
The intranasal route seems a potential alternative for procedural pain management and sedation in neonates, especially when intravenous access is not available. However, data about safety remain limited. Reported sides effects could be attributed to molecules used rather than the intranasal route. Optimal drugs and doses still need to be characterized. Further studies are needed to ensure safety before promoting a widespread use of intranasal medications in neonatology.
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