Opioids for procedural pain in neonates.

Area of Science:

• Neonatal care
• Pain management
• Pharmacology

Background:

• Neonates undergo numerous painful procedures for diagnostic, therapeutic, or surgical reasons.
• Opioids like morphine, fentanyl, and remifentanil are commonly used for neonatal pain, but may impact brain development.
• Non-pharmacological interventions and other drugs are alternative pain management options.

Purpose of the Study:

• To evaluate the benefits and harms of opioid use in neonates experiencing procedural pain.
• Comparisons include placebo, no drug, non-pharmacological interventions, other analgesics/sedatives, and other opioids or routes of administration.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Included preterm and term infants up to 46 weeks postmenstrual age exposed to procedural pain.
• Primary outcomes: pain assessment using validated scales and adverse events. GRADE methodology used to assess evidence certainty.

Main Results:

• Opioids probably reduce pain scores (PIPP/PIPP-R, NIPS) during procedures compared to placebo (moderate to low certainty evidence).
• Opioids may increase apnea episodes (low certainty evidence), with very uncertain evidence for bradycardia and hypotension.
• Evidence is very uncertain for comparisons with non-pharmacological interventions or other analgesics, and for different opioid types or administration routes.

Conclusions:

• Opioids likely offer pain relief during neonatal procedures compared to placebo, with moderate certainty.
• Potential increase in apnea episodes requires careful consideration.
• Significant uncertainty exists regarding other comparisons and adverse events, highlighting the need for more high-quality research.