Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit.

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.

The association of AIDS education and sex education with sexual behavior and condom use among teenage men.

According to a 1988 nationally representative survey, most 15-19--year-old men in the United States have received formal instruction about AIDS (73%), birth control (79%) and resisting sexual activity (58%). Results of multivariate analyses show the receipt of AIDS education and sex education to be associated with modest but significant decreases in the number of partners and the frequency of intercourse in the year prior to the survey. Having received instruction in these topics was also associated with more consistent condom use. Instruction in some topics was associated with increases in knowledge and attitudes about AIDS, but these increases were not always correlated with safer behavior.

PIP: Multivariate and 1 and 2-limit to bit models were used to analyze data from 1880 noninstitutionalized, never-married men 15-19 years of age included in the US 1988 National Survey of Adolescent Males (NSAM). Cross-sectional data are compared in order to assess the levels of sexual behavior and condom use after AIDS and sex education. Condom consistency rates were calculated. Race, age, urban residence, annual family income, family receipt of welfare within the last 12 months, religious denomination, school attendance, the state incidence of AIDS/100,000 population, and confirmation of mother's teenage pregnancy were used to control for confounding factors. AIDS knowledge and attitudes were also obtained. The 1-limit tobit model was used to analyzed the number of partners and acts of intercourse. Condom use was analyzed with a 2-limit tobit model. The findings were that there has been widespread receipt of AIDS education and sex education in topics on AIDs, birth control biology, and resistance skills, which accounted for 77% of the variance in the 8 topics and were significantly correlated. The receipt of AIDS education was associated with decreases in the number of sexual partners, after controlling for race, age, religion, and other background variables. AIDS education was responsible for 1) a 4% increase in the proportion of students with recent sexual partners (within the past 12 months); 2) a mean reduction of .12 partners among those with recent sex partner; 3) a 7% decrease in the proportion who had never used condoms; recently sex partner; 4) a 9% increase in the proportion using condoms 100% of the time; and a mean increase of 2% among all who ever used a condom. Age, ethnic group, religion, urban residence, and presence of a teenage mother were significant variables in the analysis of AIDS education effects, and the relationship is indicated. In the analysis of other sex education, only AIDS, resistance skills, and birth control were analyzed. Each topic was associated with an increase in condom use (t = 1.91=1.98 at p = .05). In the ordinary least squares analysis, the association between instruction and behavior was not mediated by changes in knowledge or attitudes. No topic affected the perceived risk of infection. Resistance instruction has a strong independent association with fewer sexual partners and acts of intercourse. An integrated and comprehensive approach to HIV education and sex education is suggested. Self-reporting and selection biases are discussed as limitations.

Levels of sexual activity among adolescent males in the United States.

Although three-fifths of adolescent males aged 15-19 say they have had sexual intercourse, analyses of data from the 1988 National Survey of Adolescent Males indicate that their level of sexual activity is relatively moderate. The data show that among sexually experienced young men the mean number of partners in the last 12 months is 1.9, and the mean frequency of intercourse in the last four weeks is 2.7 times. Black males have had more partners than white or Hispanic males; however, after the number of years since first intercourse are controlled for, these differences disappear. On average, sexually experienced youth spent six out of the last 12 months with no sexual partner, and only 21 percent of sexually active males had more than one partner in any month in the last year. Comparisons with 1979 data suggest that proportionately more adolescents were sexually experienced in 1988, but fewer non-black males had first intercourse before their 15th birthday. The number of partners since first intercourse and in the past four weeks appears to have decreased, as has the frequency of intercourse in the last four weeks.

PIP: Researchers used data on 1880 never married males aged 15-19 years living in the United States collected during the 1988 National Survey of Adolescent Males (NSAM) to gauge heterosexual activity by the number of partners and the frequency of coitus and, when possible, to compare these data with data collected during the 1979 National Survey of Young Men. In 1988, 60% had sexual intercourse at least once, but most of them did not have any partners for 5.87 months and only 21% had 1 relationship at the same time during the last 12 months. 19.8% of young Black males said they had had sexual intercourse by age 13 compared to 2.9 of White males and 3.9 of Hispanic males (p.001). Indeed the cumulative proportion of Black teenagers who had 1st intercourse continued to be significantly greater than those of White and Hispanic teenagers (p.001 for 13-18 years; p.05 for 19 years). Overall male adolescents had an average of 5.11 lifetime sexual partners. The 17-19 year olds in 1988 (6) had significantly fewer lifetime partners than those in 1979 (7.34; p.001). Further, the number fell between 1979-1988 in each age group, but the decrease was only significant for 19 year olds (p.05). The number of partners actually rose for Blacks (9.34-9.99), but fell greatly for Nonblacks (6.87-5.02; p.01). In 1988, Blacks had a mean of 8.3 partners compared to 4.3 for Whites and 5.2 for Hispanics (p.001). The mean number of sexual partners in the last year was significantly greater for Blacks (2.37) than Whites (1.85) and Hispanics (1.57; p.001). The number of partners in the last 4 weeks fell significantly between 1979-1988 (.96 vs. .72; p.05). This decline was essentially due to the substantial drop in partners for Blacks (1.32 vs. .86; p.01). These results indicated that overall the rate of sexual activity is declining and that serial monogamy is the norm for male teenagers who have had 1 partner in the last year.

Contraceptive attitudes and intention to use condoms in sexually experienced and inexperienced adolescent males.

PIP: The 1988 National Survey of Adolescent Males, conducted by the Institute for Survey Research of Temple University, interviewed 1880 never-married males, aged 15-19, over the period April-November 1988. The sample is representative of the noninstitutionalized, never-married male population aged 15-19 in the contiguous US, with young men in college dormitories, military barracks, prisons, and other group quarters excluded from the sampling frame. The sample was stratified to overrepresent Black and Hispanic respondents such that 676 Black males, 386 Hispanic males, and 755 White, non-Hispanic males, as well as 63 males of other races were interviewed. 1244 of the men had experienced sexual intercourse, 421 had not experienced intercourse but intended to do so in the near future, and 159 were sexually inexperienced and intended to remain so for some time. Sexually inexperienced respondents who did not intend to have sex are omitted from the analysis. 58.3% of the sexually experienced males and 58.0% of the inexperienced males intending to have sex in the next year reported being almost certain that they would use a condom with an hypothetical future partner. Sexually experienced males reported lower perceived costs for condom use related to embarrassment than did the inexperienced males. Experienced males, however, perceive condoms as being more costly in terms of reducing pleasure. The perceived benefits of using condoms in terms of preventing pregnancy and gaining appreciation from the partner, as well as attitudinal endorsement of male responsibility in contraception more generally, are similar for the two groups. Believing that males are responsible for contraception and perceiving condoms to have low costs in terms of reducing pleasure and high benefits in gaining the partner's appreciation influence intent to use a condom. Attitudes discounting the risk of AIDS reduced intended condom use in both groups. For the sexually inexperienced, urban residence, high educational aspirations, and self-esteem were also associated with the intention to use a condom. For experienced respondents, condom use at last intercourse, not being Hispanic, holding religion to be important, liberal attitudes about the male sex role, and worry about AIDS also predict intended condom use.^ieng

Sexual activity, condom use and AIDS awareness among adolescent males.

New data from the 1988 National Survey of Adolescent Males indicate that 60 percent of never-married young men ages 15-19 are sexually active. Among 17-19-year-old males living in metropolitan areas, the rate of sexual activity reported in 1988 was 15 percent higher than that reported in 1979. This increase encompasses a rise of 23 percent among black males and 13 percent among nonblack males. Slightly more than half of the sexually active males in the 1988 survey reported that they had used a condom the last time they had had intercourse. Among both black and nonblack youths aged 17-19 living in metropolitan areas, rates of reported condom use at last intercourse more than doubled between 1979 and 1988. Conversely, reported reliance on ineffective methods of contraception or use of no method at last intercourse was 60 percent lower. When first intercourse occurred within two years of the 1988 survey, the odds of using a condom were increased by 110 percent over the odds when intercourse occurred between 1975 and 1982, after controlling for the effects of age at first intercourse, race and ethnicity. The young men in the sample were very knowledgeable about how the human immunodeficiency virus is transmitted, and over three-quarters of the sample did not dismiss the disease as uncommon, nor did they think that using condoms to prevent the spread of AIDS was too much trouble. The rates of condom use were significantly lower than average, however, among young men who had ever used drugs intravenously or whose partners had done so, young men who had ever had sex with a prostitute and those who had had five sexual partners or more in the past year.

Body composition and physical activity in 8-year-old children.

Body measurements and determinations were made of normal children age 8 3/4 yr. Anthropometric indices most highly correlated with percentage fat as determined by body density were the sum of four skinfolds, relative weight, and triceps skinfold thickness. Girls had a significantly higher percentage of fat than boys. Percentage fat at this age was compared to longitudinal activity scores (based on 1-day activity records) obtained from 6 months to the current age. There was no significant correlation of activity with fatness in girls. In boys, activity at 3 and 4 yr had a significant negative correlation with fatness at age 8; activity at age 8 was not correlated. Relative-leanness-fatness was better related to past than current activity. Comparison of longitudinal activity scores revealed a continuity of activity patterns for short intervals (e.g., 1 yr), but over longer periods (e.g., 4 or more yr) the effect diminished.

Effects of steroid hormones on human polymorphonuclear leukocyte lysosomes.

Lysosomal membrane stabilization has been proposed as a mechanism for the anti-inflammatory action of corticosteroid hormones. This hypothesis was based on studies with liver organelles. We studied the action of steroids on intact lysosomes isolated from human peripheral blood polymorphonuclear (PMN) leukocytes. Both androstenedione and progesterone, 10(-3)-10(-5) M, caused leakage of acid hydrolase markers from these organelles, thus resembling their effects on liver lysosomes. But none of the anti-inflammatory steroids tested protected organelle membranes from either detergent lysis (Triton X-100) or heat incubation (37 degrees C, 90 min). Hydrocortisone (HC), HC sodium succinate, HC acetate, HC hemisuccinate, prednisone, and dexamethasone were without detectable stabilizing activity at concentrations of 10(-3)-5 x 10(-8) M. Release of the lysosomal marker, beta-glucuronidase, was not retarded by any of the compounds studied. In addition, PMN leukocyte lysosomes isolated from human volunteers receiving prednisolone were not more stable than control organelles, nor did serum from steroid-treated humans protect intact lysosomes from detergent lysis. Variations in cholesterol and phospholipid contents of liver and PMN leukocyte lysosome membranes could possibly account for the different reactivity to corticosteroids observed. We believe that the anti-inflammatory activity of adrenal corticosteroids can best be explained by their inhibitory effects on cellular metabolism rather than by their direct interaction with lysosomal membranes.