Abstract
Background. — Mild methemoglobinemia is a known side-effect of one of the constituents of EMLA® cream, this topical local anesthetic is used with great caution in neonates. Population and methods. — One hundred and sixteen neonates admitted from January to July 1994 in an intensive care unit were included in the study. All required skin punctures which were performed 1h30-2 hours after EMLA® had been applied on the skin. A reaction score (0 to 5) to skin puncture was established 157 times (120 after and 37 without local anesthesia); methemoglobin (Met Hb) concentrations were measured in 47 blood samples, 18–24 hours (40.4% of samples) or 2–3 days (36.2%) after application of EMLA®. Results. — Ninety-four neonates were quiet before puncture (score 0–1). Among them, 57% of those who were given EMLA® has a low score (2 or less) vs 18% without EMLA ®. A low reaction was observed in 65% when the dressings had been kept in place for at least 90 minutes vs 15% with a shorter application. A lower reaction was noted in 78.8% of cases after venopuncture (41% after arterial puncture). No Met Hb level was sbove 5% and 7 (15%), in five neonates, were between 3 and 5%. There was no clear relationship between methemoglobinea and gestational age or duration of dressing. Conclusion. — EMLA® cream is effective and safe in neonates including preterms, when it is applied in a small amount once a day.
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