Physiological, hormonal, and behavioral responses to a single fentanyl dose in intubated and ventilated preterm neonates

• Published in: The Journal of pediatrics Vol. 132; no. 6; pp. 954 - 959
• Main Authors: Guinsburg, Ruth, Kopelman, Benjamin Israel, Anand, K.J.S., Branco de Almeida, Maria Fernand, de Araujo Peres, Clovis, Miyoshi, Milton Harumi
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.1998; Elsevier
• Subjects: Analgesia; Analgesics, Opioid; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Glucose - analysis; Catheterization, Central Venous; Double-Blind Method; Emergency and intensive respiratory care; Female; Fentanyl; Hemodynamics; Human Growth Hormone - blood; Humans; Hydrocortisone - blood; Infant, Newborn; Infant, Premature - physiology; Intensive care medicine; Intubation, Intratracheal; Lactic Acid - blood; Male; Medical sciences; Pain - physiopathology; Pain - prevention & control; Pain Measurement; Respiration, Artificial; Time Factors; NFCS; GH; PCS; Human; Premature; Pediatrics; Evaluation; Adaptive response; Fentanyl; Controlled therapeutic trial; Opiates; Narcotic analgesic; Randomization; Newborn; Mechanical ventilation; Resuscitation
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(98)70390-7

Objective: To study the responses of ventilated preterm neonates to a single dose of opioid. Study design: In a randomized, double-blind, controlled trial, 22 mechanically ventilated preterm infants (≤32 weeks) were observed before medication and at 30 and 60 minutes after administration of fentanyl (3 μg/kg) or placebo. Heart rate, blood pressure, arterial blood gases, ventilator settings, and behavioral measures (Neonatal Facial Coding System and Modified Postoperative Comfort Score) were recorded during each period. Blood cortisol, growth hormone, glucose, and lactate were measured before and at 60 minutes after analgesia. Behavioral measures were assessed at the bedside and from video films recorded during each observation period. Results: Patients presented high basal levels of cortisol, growth hormone, and lactate. Behavioral scales indicated the presence of pain before any medication. In the fentanyl group, the maximum and minimum heart rate decreased and growth hormone level increased after analgesia. At the video analysis of behavioral measures, postoperative comfort score increased and neonatal facial coding system score decreased in the fentanyl group. Conclusion: Single doses of fentanyl analgesia can reduce the physiologic/behavioral measures of pain and stress associated with mechanical ventilation in preterm infants.(J Pediatr 1998;132:954-9.)