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Drug withdrawal symptoms in children after continuous infusions of fentanyl
1School of Nursing and the Department of Pediatrics, University of North California at Chapel Hill.
Insights
Critically ill infants receiving continuous fentanyl infusions may experience narcotic withdrawal symptoms. Higher fentanyl doses and longer infusion times correlated with increased withdrawal severity, suggesting a need for monitoring protocols.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatal Pharmacology
- Pain Management
Background:
- Fentanyl is commonly used for sedation and analgesia in critically ill infants.
- Prolonged opioid use can lead to physical dependence and withdrawal symptoms upon discontinuation.
- Neonatal Abstinence Syndrome (NAS) is a recognized concern in infants exposed to opioids.
Purpose of the Study:
- To assess the incidence and severity of narcotic withdrawal in critically ill infants after continuous fentanyl infusion.
- To identify factors correlating with the development of withdrawal symptoms.
Main Methods:
- A convenience sample of 12 pediatric intensive care unit (PICU) patients under 25 months received fentanyl infusions for ≥24 hours.
- Neonatal Abstinence Score Tool (NAST) was used to monitor withdrawal symptoms hourly for 8 hours post-infusion.
- Correlation analysis was performed between fentanyl dosage, infusion duration, chloral hydrate dosage, and NAST scores.
Main Results:
- Six out of 12 infants (50%) exhibited signs of Neonatal Abstinence Syndrome (NAS) with NAST scores >8.
- Common withdrawal symptoms included tremors, increased muscle tone, insomnia, and increased respiratory rate/effort.
- Significant positive correlations were found between fentanyl dosage (r=.76), infusion length (r=.70), and chloral hydrate dosage (r=.62) with NAST scores.
Conclusions:
- Continuous fentanyl infusions in critically ill infants are associated with a significant risk of narcotic withdrawal.
- Fentanyl dosage and duration of infusion are key predictors of withdrawal severity.
- Implementation of observation protocols and potential weaning regimens is recommended upon fentanyl discontinuation.
Abstract:
The purpose of this research was to determine the extent to which critically ill infants exhibited signs and symptoms of narcotic withdrawal after receiving continuous infusions of fentanyl. The convenience sample consisted of 12 pediatric intensive care unit (PICU) patients under 25 months of age who received fentanyl infusions for at least 24 hours. Drug withdrawal symptoms were monitored using the Neonatal Abstinence Score Tool (NAST), which assigns a score to each behavior indicative of withdrawal. A score of 8 or greater indicates Neonatal Abstinence Syndrome (NAS). Scoring began 4 hours after discontinuation of fentanyl and was conducted once per hour for 8 hours. Six subjects had a NAST score exceeding 8; these infants frequently exhibited tremors with or without stimulation, increased muscle tone, insomnia, and increased respiratory rate and effort. There were significant correlations between fentanyl dosage and NAST score (r = .76, p < 0.01), between length of infusion of fentanyl and NAST score (r = .70, p < 0.05), and between chloral hydrate dosage and NAST score (r = .62, p < 0.05). These findings suggest the need for an observation protocol and a possible weaning regimen after fentanyl is discontinued.