Intranasal Analgesia in Preterm and Term Neonates

Area of Science:

• Neonatal care
• Pharmacology
• Pain management

Background:

• Neonatal pain management is critical due to infants' immature antalgic systems and increased stress responses.
• Untreated pain in infants is linked to adverse neurodevelopmental outcomes, including poorer cognitive and motor scores.
• Intranasal drug delivery presents advantages over oral administration, such as faster absorption and avoidance of gastrointestinal effects.

Purpose of the Study:

• To review evidence on intranasal drug administration for pain management in neonates.
• To provide a practical guide on dosages and indications for intranasal drugs in the neonatal population.
• To highlight specific intranasal agents suitable for neonatal pain and sedation.

Main Methods:

• Literature review of studies on intranasal drug delivery for neonatal pain.
• Analysis of pharmacokinetics and pharmacodynamics of common analgesics in infants.
• Synthesis of current evidence on specific intranasal agents for neonatal use.

Main Results:

• Intranasal fentanyl is a viable option for procedural/palliative pain in preterm infants lacking IV access.
• Intranasal midazolam is suitable for sedation in term/near-term neonates.
• Ketamine and dexmedetomidine show promise for specific neonatal sedation and pain management scenarios, with dexmedetomidine well-tolerated in preterm infants.

Conclusions:

• Intranasal medications offer effective and practical alternatives for neonatal pain and sedation.
• Specific agents like fentanyl, midazolam, ketamine, and dexmedetomidine have distinct roles in neonatal care.
• Further research and clinical application of intranasal routes can optimize neonatal pain management strategies.