A cohort study of intranasal fentanyl for procedural pain management in neonates.

OBJECTIVES: The objective of this cohort study was to document experience with intranasal (IN) fentanyl analgesia for procedural pain management in neonates in a surgical neonatal intensive care unit. A consecutive sample of 23 neonates without intravenous access treated with IN fentanyl was included. METHODS: Data were extracted from medical charts, including infant characteristics, indication for IN fentanyl, dose, physiologic parameters (heart rate, respiratory rate, oxygen saturation, blood pressure) and pain scores. Physiologic parameters were recorded for 6 hours before and after IN fentanyl. Pain scores were recorded during and after the procedure using the Premature Infant Pain Profile (PIPP). RESULTS: The mean (SD) postmenstrual age of included infants was 31.8 weeks (4.1), and 52% were receiving some form of ventilator support. The mean dose of IN fentanyl was 1.3 mcg/kg (0.4) and most common indication was analgesia for peripheral insertion of central catheter. There were six cases of cardiorespiratory depression as defined, however, clinical factors could account for all of them. The mean PIPP score during and after the procedure was 4.3 (1.8) and 3.6 (1.5), respectively (scores <6 indicate no pain). CONCLUSIONS: This small study provides some preliminary evidence of the benefits and risks of IN fentanyl in this population.

Analysis of continuous oxygen saturation data for accurate representation of retinal exposure to oxygen in the preterm infant.

Maintaining blood oxygen saturation within the intended target range for preterm infants receiving neonatal intensive care is challenging. Supplemental oxygen is believed to lead to increased risk of retinopathy of prematurity and hence managing the level of oxygen within this population is important within their care. Current quality improvement activities use coarse hourly spot readings to measure supplemental oxygen levels as associated with targeted ranges that vary based on gestational age. In this research we use Artemis, a real-time online healthcare analytics platform to ascertain if the collection of second by second data provides a better representation of retinal exposure to oxygen than an infrequent, intermittent spot reading. We show that Artemis is capable of producing more accurate information from the higher frequency data, as it includes all the episodic events in the activity of the hour, which provides a better understanding of oxygen fluctuation ranges which affect the physiological status of the infant.