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.
Highlights
As advances in pediatric critical care medicine have allowed for increased survival rates and management of more critically ill neonates and infants, the need for prolonged sedation and analgesia has increased
Original studies with increased dosing and prolonged administration of opioids during neonatal and pediatric intensive care [4,6] demonstrated that neonates, infants, and children rapidly develop analgesic tolerance and physical dependence
Neurological involvement was present in almost half of identified critically ill full-term infants that underwent sedation >3 days (20/44)
Summary
As advances in pediatric critical care medicine have allowed for increased survival rates and management of more critically ill neonates and infants, the need for prolonged sedation and analgesia has increased. Even without a source of surgical pain, critically ill infants and children receive sedation to reduce anxiety, agitation, and stress responses, and to facilitate ventilation [2]. Original studies with increased dosing and prolonged administration of opioids during neonatal and pediatric intensive care [4,6] demonstrated that neonates, infants, and children rapidly develop analgesic tolerance (defined as escalating drug dosage to achieve the same level of pain relief achieved initially) and physical dependence (defined as an adaptive state that develops from repeated drug administration and results in withdrawal upon cessation of drug use).
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