Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome☆,☆☆,★
Section snippets
METHODS
This study was approved by the investigational review board at the Medical Center of Delaware. After informed parental consent was obtained, 20 premature neonates receiving mechanical ventilation for RDS were enrolled in this investigation. To be eligible for this study, infants had to have clinical and radiographic evidence of RDS, have a birth weight greater than 1 kg and a gestational age of 26 to 36 weeks, be receiving mechanical ventilation, and have an indwelling arterial catheter. All
RESULTS
Twenty infants were enrolled into this study. Nine infants were randomly assigned to receive placebo and 11 infants to receive fentanyl. Patient characteristics are listed in Table I. Of the 20 infants, 19 received exogenous surfactant (Exosurf) as treatment for RDS. There were no differences in race, sex, Apgar scores, or method of delivery between the two groups.
Data are shown in Table II (all data are mean ± SD). There were no differences at 8 hours into the study with respect to any of the
DISCUSSION
The results of this study indicate that although fentanyl can alter physiologic indicators of pain and stress when given routinely to infants with RDS, there was no improvement in catabolic state or long-term outcome. In addition, the data also show that infants receiving fentanyl required increased ventilatory support in comparison with the infants receiving placebo.
Although fentanyl is currently a popular medication in neonatal practice, there are few reports available that critically examine
Acknowledgements
We thank the neonatal intensive care nurses at the Medical Center of Delaware for their help during this study. Their continued support of research and their devotion to the care of our patients is greatly appreciated.
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Cited by (102)
Neonatal Pain and Stress
2023, Avery's Diseases of the NewbornPharmacologic therapies
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionEvaluations of Morphine and Fentanyl for Mechanically Ventilated Patients With Respiratory Disorders in Intensive Care: A Systematic Review of Methodological Trends and Reporting Quality
2019, Value in Health Regional IssuesCitation Excerpt :Only 7 studies featured head-to-head comparisons between morphine and fentanyl.16,21,23,24,27,33,40 Morphine was evaluated as monotherapy (n = 9) and/or in combination (n = 16) in 23 studies,12–14,16,17,20,21,23–31,33–36,39–42 whereas fentanyl was evaluated as monotherapy (n = 7) or in combination (n = 8) in 15 of the 33 studies.15,16,18,19,22–24,27,32,33,37,38,40,43,44 Table 1 and Appendices 5 and 6 in Supplemental Materials found at https://doi.org/10.1016/j.vhri.2018.11.001 present the study interventions and comparators.
Clinical and Economic Analysis of Morphine Versus Fentanyl in Managing Ventilated Neonates With Respiratory Distress Syndrome in the Intensive Care Setting
2019, Clinical TherapeuticsCitation Excerpt :For example, tachyphylaxis is more rapidly developed with fentanyl than with morphine,27 which is an issue in patients with seizures because of the development of withdrawal symptoms. In addition, although fentanyl mostly produces similar respiratory depression as morphine at equivalent doses, fentanyl potentially causes adverse pulmonary impact independent of respiratory depression.39 Another example is that in cases of well-controlled settings in which resources are available to rapidly and adequately manage associated side effects, such as bradycardia and chest wall rigidity, fentanyl is preferred as a rapidly acting opioid for analgesia.31
Neonatal Pain and Stress: Assessment and Management
2018, Avery's Diseases of the Newborn: Tenth EditionNeonatal Pain and Stress: Assessment and Management
2017, Avery's Diseases of the Newborn, Tenth Edition
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From the Divisions of Neonatology, Anesthesiology, and Pediatric Critical Care, Jefferson Medical College and Univerity of Pennsylvania, Philadelphia; the Medical Center of Delaware, Newark; and the Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Reprint requests: John L. Stefano, MD, Division of Neonatology, Christiana Hospital, PO Box 6001, Newark, DE 19718.
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0022-3476/96/$5.00 + 0 9/22/73091