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Opioid and sedative use in extremely preterm infants receiving mechanical ventilation
Zoe Henderson1, Grace Fuller2, Daniel K Benjamin3
1School of Medicine, University of New Mexico, Albuquerque, NM, USA.
Insights
Opioid and sedative use is common in mechanically ventilated preterm infants. High-frequency ventilation, compared to conventional, significantly increases the odds of medication exposure, highlighting a need for optimized respiratory support strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Pharmacology
Background:
- Mechanical ventilation is frequently required for preterm infants.
- Opioid and sedative medications are often administered to these vulnerable patients.
- Understanding medication exposure patterns is crucial for optimizing care.
Purpose of the Study:
- To quantify the exposure of preterm infants to specific opioid and sedative medications.
- To investigate the association between respiratory support methods and medication administration.
Main Methods:
- A cohort study included infants born <28 weeks' gestation requiring mechanical ventilation.
- Medication exposures (morphine, fentanyl, midazolam, lorazepam) were analyzed.
- Logistic regression examined the link between daily respiratory support and medication probability.
Main Results:
- 42% of 36,067 infants received at least one medication.
- Fentanyl and benzodiazepine exposure decreased from 2012 to 2020.
- High-frequency ventilation days had >2x the odds of medication administration compared to conventional ventilation.
Conclusions:
- Opioid and sedative use is prevalent in preterm infants on mechanical ventilation.
- High-frequency mechanical ventilation is associated with increased medication exposure.
- Further research into respiratory support optimization and its impact on sedation/analgesia is warranted.
Objective:
Quantify opioid and sedative medication exposures in preterm infants receiving mechanical ventilation.
Study Design:
Cohort study of infants <28 weeks' gestation receiving any mechanical ventilation in the first 28 postnatal days. We examined exposure to morphine, fentanyl, midazolam, and lorazepam. We used logistic regression to examine the association between daily respiratory support and probability of medication administration.
Results:
Of 36,067 infants, 15,025 (42%) received one or more medications. There was a decrease in exposure to fentanyl and benzodiazepines from 2012 to 2020. Major morbidities were lower in unexposed infants. The odds of receiving target medications were more than twice as high on high frequency mechanical ventilation days compared to conventional mechanical ventilation days (unadjusted odds ratio 2.47, 95% CI 2.36-2.59).
Conclusion:
In preterm infants receiving mechanical ventilation, the use of opioids or sedatives was common and high frequency ventilation was associated with higher exposure to medications.
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