Association between fentanyl use and reduced risk of tension pneumothorax in extremely preterm infants born at 22-23
Tomonori Kurimoto1, Tokuhisa Takuya1, Hiroshi Ohashi1
1Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
Insights
Fentanyl use may reduce the risk of tension pneumothorax in extremely preterm infants (22-23 weeks gestation). This finding could improve survival rates for vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Pharmacology
Background:
- Tension pneumothorax is a critical, life-threatening complication in extremely preterm infants, particularly within 72 hours of birth.
- Preventive strategies are essential for improving survival rates in this vulnerable population.
Purpose of the Study:
- To investigate the association between fentanyl administration and the incidence of tension pneumothorax.
- To evaluate the potential protective effect of fentanyl in extremely preterm infants born at 22-23 weeks of gestation.
Main Methods:
- A retrospective case-control study was conducted involving 138 infants born between 22 weeks 0 days and 23 weeks 6 days gestation.
- Logistic regression and propensity score matching were employed to control for confounding variables including chorioamnionitis, oligohydramnios, antenatal steroids, ventilation strategies, and perinatal center type.
Main Results:
- Sixteen infants (11.6%) developed tension pneumothorax within 72 hours of birth, with a high mortality rate of 68.7%.
- Fentanyl use was significantly associated with a reduced risk of tension pneumothorax (adjusted odds ratio: 0.1; 95% CI: 0.01-0.75).
Conclusions:
- Fentanyl administration may be a protective factor against tension pneumothorax in extremely preterm infants (22-23 weeks gestation) within the first 72 hours of life.
- Further randomized controlled trials are warranted to confirm these findings and explore long-term infant outcomes.
Background:
Tension pneumothorax is a life-threatening complication in extremely preterm infants, especially within the first 72 hours of life. Identifying preventive strategies is crucial to improving survival rates. This study aimed to evaluate the association between fentanyl use and the incidence of tension pneumothorax in extremely preterm infants born at 22-23 weeks of gestation.
Methods:
This retrospective case-control study was conducted at a tertiary care center in Japan. It included 138 preterm infants with a gestational age from 22 weeks + 0 days to 23 weeks + 6 days (January 2010 to March 2023). Logistic regression and propensity score matching were used to adjust for confounding factors such as chorioamnionitis stage 2-3, oligohydramnios, antenatal steroids, ventilation mode, persistent pulmonary hypertension, and birth at a primary or secondary perinatal center.
Results:
Sixteen infants (11.6%) developed tension pneumothorax within 72 h of birth, with a mortality rate of 68.7%. The use of fentanyl was associated with a reduced risk of tension pneumothorax (adjusted odds ratio: 0.1; 95% confidence interval: 0.01-0.75).
Conclusion:
The use of fentanyl may reduce the risk of tension pneumothorax within the first 72 h of life in infants born at 22-23 weeks of gestation. Further randomized controlled trials are needed to validate these findings and assess long-term outcomes.
Related Concept Videos
01:26Pneumothorax-I
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
01:27Pneumothorax-II
Clinical Manifestations:
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...