Evaluation of Postnatal Sedation in Full-Term Infants

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.

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

“…Our preliminary findings implicate possible pre-existing (pre-Foker) CC findings 53 , similar to those previously reported for infants undergoing cardiac surgery and congenital diaphragmatic hernia 41 . (2) Study Groups: We lack a true control group since (1) there is no alternate treatment for LGEA that does not involve surgery, (2) there are a limited number of infants with prolonged sedation (without surgery) 11 , or (3) otherwise healthy preterm infants that did not require medical care. Therefore, premature infants with LGEA served as a positive control, while otherwise healthy full-term controls served as negative control in this pilot study.…”

“…Patients' eligibility criteria were: full-term (37 to 42 weeks GA at birth) and moderate-to-late preterm (28 to 36 weeks GA at birth) patients <1 year gestation-corrected age that underwent surgery for Foker process for LGEA repair 1,22 . We selected infants that required prolonged postoperative sedation (≥5 days) associated with development of pharmacological dependence to drugs of sedation 11,[23][24][25] . Representative timeline illustrating sequence of perioperative critical care was presented previously 6,26 .…”

“…We previously reported that critically ill full-term and premature infants following LGEA repair had previously unrecognized clinically significant MRI findings, as well as quantitative increase of cerebrospinal fluid and globally decreased brain size 6,10 . In the same pilot cohort of full-term and premature patients, we also illustrated qualitative MRI findings implicating abnormal thinning of the corpus callosum (CC) 6 following completion of complex perioperative critical care for LGEA that included Foker process 1,2 and prolonged postoperative sedation (≥5 days) 11 . The CC forms the major commissural white matter tract important for integrating and transferring interhemispheric signals spanning sensory, motor, and higher-order cognitive domains 12 , and is formed as early…”

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

“…Complex perioperative care included several stages [23]: (1) Foker I thoracotomy to place traction sutures onto blind esophageal ends; (2) Esophageal lengthening, which uses continuous traction on the esophagus to induce esophageal growth; (3) Foker II thoracotomy to approximate esophageal ends and perform primary esophageal anastomosis; (4) Post-Foker healing of the anastomosis. To facilitate postoperative mechanical ventilation, infants underwent prolonged sedation (≥5 days), that led to pharmacological dependence to sedative agents [12,24,25] requiring subsequent weaning from sedation medications (viz. opioids and benzodiazepines).…”

“…Previous reports revealed abnormalities in pain processing, neurodevelopment, and behavior following repeated invasive procedures [10]. While administration of analgesics may reduce the stress associated with pain and discomfort, prolonged sedation leads to the development of tolerance and dependence if administered for ≥5 days, requiring subsequent weaning and a prolonged hospital stay [11,12].…”