ABSTRACT
BACKGROUND: The intranasal route is a minimally invasive method for rapidly delivering midazolam and fentanyl to provide short-term analgesia and sedation in infants. However, intranasal use of midazolam and fentanyl is not labeled for infants and safety data are sparse. The objective of this study is to evaluate the safety of intranasal midazolam and intranasal fentanyl in infants admitted to the Neonatal Intensive Care Unit (NICU). METHODS: We retrospectively identified all infants receiving intranasal midazolam or fentanyl in the NICU from 2009 to 2015. We recorded indication for use and vital signs and determined the proportion of infants experiencing the following adverse events: death within 24 hours, hypotension, bradycardia, worsening respiratory status, and chest wall rigidity. Vital signs 4 hours before and after each dose were compared using the Wilcoxon signed-rank test. RESULTS: We identified 17 infants (gestational ages 23- 41 weeks) receiving 25 intranasal doses. None of the infants died or developed hypotension, bradycardia, or chest wall rigidity. Intranasal delivery was most commonly used for sedation during magnetic resonance imaging studies. Other indications include analgesia or sedation for retinopathy of prematurity surgery, intubation, and peripherally inserted central catheter placement. One infant receiving intranasal midazolam experienced worsening respiratory status. Vital signs before and after dosing were not significantly different. CONCLUSIONS: Intranasal midazolam and fentanyl use in term and preterm infants appeared safe and well-tolerated in this small cohort of infants. Larger, prospective studies evaluating the safety and efficacy of intranasal midazolam and fentanyl use in infants are warranted.
Subject(s)
Analgesics, Opioid/administration & dosage , Fentanyl/administration & dosage , Hypnotics and Sedatives/administration & dosage , Midazolam/administration & dosage , Pain, Procedural/prevention & control , Administration, Intranasal , Analgesics, Opioid/therapeutic use , Arterial Pressure , Bradycardia/epidemiology , Catheterization, Peripheral , Female , Fentanyl/therapeutic use , Humans , Hypnotics and Sedatives/therapeutic use , Hypotension/epidemiology , Infant, Newborn , Intensive Care Units, Neonatal , Intubation, Intratracheal , Magnetic Resonance Imaging , Male , Midazolam/therapeutic use , Mortality , Ophthalmologic Surgical Procedures , Respiratory Distress Syndrome, Newborn/epidemiology , Respiratory Rate , Retinopathy of Prematurity/surgery , Retrospective Studies , Risk Factors , Thoracic WallABSTRACT
Infant delirium is an under-recognized clinical entity in neonatal intensive care, and earlier identification and treatment could minimize morbidities associated with this condition. We describe a case of a 6-month-old former 32 weeks gestation infant undergoing a prolonged mechanical ventilation course diagnosed with delirium related to the combination of his underlying illness and the use of multiple sedative and analgesic medications. Initiation of the atypical antipsychotic risperidone allowed for weaning from continuous infusions of benzodiazepines and opiods, and lower dosages of bolus-dosed sedation and analgesics. The patient experienced no adverse side effects from use of this neuroleptic.
Subject(s)
Analgesics, Opioid/adverse effects , Cardiac Catheterization , Delirium/therapy , Deprescriptions , Hypnotics and Sedatives/adverse effects , Postoperative Complications/therapy , Respiratory Distress Syndrome, Newborn/psychology , Amines/therapeutic use , Anti-Anxiety Agents/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Delirium/etiology , Dexmedetomidine/adverse effects , Diazepam/adverse effects , Female , Fentanyl/adverse effects , Gabapentin , Humans , Infant , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Methadone/adverse effects , Midazolam/adverse effects , Phenobarbital/adverse effects , Postoperative Complications/etiology , Pregnancy , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/complications , Risperidone/therapeutic use , gamma-Aminobutyric Acid/therapeutic useABSTRACT
Pulmonary artery thrombus is a rarely reported complication in premature neonates. The management of life-threatening thrombotic events in neonates is controversial, especially regarding the use of thrombolytics versus anticoagulation alone for treatment. We report a case of a premature neonate with symptomatic pulmonary artery thrombus treated with recombinant tissue plasminogen activator who survived without bleeding complications.
Subject(s)
Fibrinolytic Agents/therapeutic use , Pulmonary Artery/pathology , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic use , Echocardiography, Doppler , Humans , Infant, Newborn , Infant, Premature , Male , Recombinant ProteinsABSTRACT
OBJECTIVE: To determine the effects of low-dose dopamine on urine output (UOP) in very low birth weight premature neonates. STUDY DESIGN: Retrospective cohort study of all low-dose (3-5 µg kg(-1) per min) dopamine infusions >24-h duration in neonates îº1500 g and îº32 weeks gestation from August 2009 through September 2011. Linear regression was used to estimate the impact of covariates on UOP. RESULT: We identified 91 episodes of low-dose dopamine use in 65 neonates. Increased UOP occurred in 64% of episodes. Low-dose dopamine use was associated with a 0.6 ml kg(-1) h(-1) increase in UOP (P<0.001) and a 1.3 ml kg(-1)h(-1) increase when baseline UOP was <1.5 ml kg(-1) h(-1) (P<0.001). The improvement remained statistically significant after controlling for medications (diuretics and hydrocortisone) and fluid intake. CONCLUSION: Low-dose dopamine use was associated with increased UOP in very low birth weight neonates.