Narcotics and Sedative Use in Preterm Neonates

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• 作者：Liron Borenstein-Levin ; MD¹ ; Anne Synnes ; MDCM ; MHSc¹ ; ² ; ³ ; ^{asynnes@cw.bc.ca} ; Ruth E. Grunau ; PhD¹ ; ² ; ³ ; Steven P. Miller ; MDCM ; MAS² ; ³ ; ⁴ ; ⁵ ; Eugene W. Yoon ; MSc⁴ ; Prakesh S. Shah ; MD ; MSc⁴ ; on behalf of the Canadian Neonatal Network Investigators^*
• 关键词：Preterm neonates ; Narcotics ; Sedatives ; Morphine
• 刊名：The Journal of Pediatrics
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：180
• 期：Complete
• 页码：92-98.e1
• 全文大小：902 K
• 卷排序：180

文摘

To evaluate patterns of narcotic and sedative use in neonatal intensive care units (NICUs) across Canada using data collected by the Canadian Neonatal Network.Study designWe conducted a retrospective observational cohort study of preterm neonates at <33 weeks' gestation and admitted to a participating Canadian Neonatal Network NICU. The proportion of all neonates who received sedative(s), narcotic(s), or either sedative(s), narcotic(s), or both during their NICU stay was calculated for each year. Because opioids are used for premedication before intubation, only continuous infusions of a narcotic drug were included. Variation in narcotics and sedative usage between sites in 2014 was determined using logistic regression analysis, with adjustment for gestational age, surgery, and mechanical ventilation.ResultsOf 20 744 neonates, 29% of neonates received a narcotic, a sedative, or both; 23% received a narcotic and 17% a sedative. Although no clinically significant changes in drug exposure were documented during the 5-year period, there were statistically significant differences in narcotic and sedative use between sites, ranging from 3% to 41% for narcotic and 2% to 48% for sedative use (aORs 0.2-5.7 and 0.1-15, respectively, P < .05).ConclusionsExposure to narcotic or sedative agents is highly variable in preterm neonates across Canada despite concerns of adverse outcomes associated with these drugs. The tremendous variation in practice suggests that further research on their current usage, as well as identifying optimal practice procedures is warranted.