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Challenges in management of refractory pain and sedation in infants

Alexandra Oschman1, Karishma Rao2,3

  • 1Department of Pharmacy, Children's Mercy Hospital, Kansas City, MO, United States.

Frontiers in Pharmacology
|January 18, 2024
PubMed

Insights

Managing pain and sedation in medically complex preterm infants in the neonatal intensive care unit (NICU) is challenging. This review explores refractory pain, sedation management, and associated clinical challenges in these vulnerable infants.

Area of Science:

  • Neonatology
  • Pediatric Critical Care
  • Pharmacology

Background:

  • Improving survival rates in preterm infants has led to an increase in medically complex infants requiring prolonged neonatal intensive care unit (NICU) stays.
  • Effective management of pain and sedation in these chronic NICU patients remains a significant clinical challenge despite advances in neonatal care.

Purpose of the Study:

  • To summarize the current literature on the diagnosis and management of refractory pain and sedation in chronic NICU patients.
  • To highlight the challenges clinicians face when managing pain and sedation in this complex pediatric population.

Main Methods:

  • Comprehensive literature review of existing studies on pain and sedation management in neonatal and infant care.
  • Analysis of challenges including the development of appropriate assessment scales and clinician unfamiliarity with pediatric disease states and pharmacotherapy.
  • Exploration of potential roles for opioid-induced hyperalgesia (OIH) and delirium in refractory cases.

Main Results:

  • Development of validated pain, sedation, and withdrawal scales is needed for this population.
  • Limited data exists on the safety and efficacy of drug therapies like gabapentin, ketamine, and risperidone in infants.
  • Opioid-induced hyperalgesia (OIH) and delirium are often overlooked but may contribute to refractory pain and sedation issues.

Conclusions:

  • Managing refractory pain and sedation in chronic NICU infants presents multifaceted challenges.
  • Further research is crucial to establish evidence-based guidelines for the safe and effective use of pharmacotherapy in this vulnerable population.
  • Addressing OIH and delirium should be considered in the comprehensive care of these complex infants.

Keywords:
NICUdeliriuminfant analgesiainfant sedationopioid-induced hyperalgesia

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