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Evaluation of Postnatal Sedation in Full-Term Infants

1
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
2
Esophageal Advance Treatment Center, Department of Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
3
Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
4
Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(5), 114; https://doi.org/10.3390/brainsci9050114
Received: 10 April 2019 / Revised: 6 May 2019 / Accepted: 16 May 2019 / Published: 17 May 2019
(This article belongs to the Special Issue Mechanisms Underlying Alleviation of Pain)
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Abstract

Prolonged sedation in infants leads to a high incidence of physical dependence. We inquired: (1) “How long does it take to develop physical dependence to sedation in previously naïve full-term infants without known history of neurologic impairment?” and (2) “What is the relationship between length of sedation to length of weaning and hospital stay?”. The retrospective study included full-term patients over a period of one year that were <1 year of age and received opioids and benzodiazepines >72 hours. Quantification of fentanyl, morphine, and midazolam were compared among three time periods: <5 days, 5–30 days, and >30 days using t-test or one-way analysis of variance. Identified full-term infants were categorized into surgical (14/44) or medical (10/44) groups, while those with neurological involvement (20/44) were excluded. Physical dependence in full-term infants occurred following sedation ≥5 days. Infants with surgical disease received escalating doses of morphine and midazolam when administered >30 days. A positive association between length of sedation and weaning period was found for both respiratory (p < 0.01) and surgical disease (p = 0.012) groups, while length of sedation is related to hospital stay for the respiratory (p < 0.01) but not the surgical disease group (p = 0.1). Future pharmacological directions should lead to standardized sedation protocols and evaluate patient neurocognitive outcomes. View Full-Text
Keywords: opioids; pain; pain management; pharmacotherapies; physical dependence; postoperative pain; midazolam; morphine; term; tolerance; weaning opioids; pain; pain management; pharmacotherapies; physical dependence; postoperative pain; midazolam; morphine; term; tolerance; weaning
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Solodiuk, J.C.; Jennings, R.W.; Bajic, D. Evaluation of Postnatal Sedation in Full-Term Infants. Brain Sci. 2019, 9, 114.

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