Gabapentin Use in the Neonatal Intensive Care Unit

Edwards, Laura; DeMeo, Stephen; Hornik, Chi Dang; Cotten, C. Michael; Smith, P. Brian; Pizoli, Carolyn; Hauer, Julie; Bidegain, Margarita

doi:10.1016/j.jpeds.2015.10.013

Cited by 54 publications

(39 citation statements)

References 10 publications

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“…Although commonly used for primary pain disorders, there is little evidence to support their use against pediatric pain. Most pediatric data for this heterogeneous class of medications is derived from neuropathic and acute pain conditions [138,139,140,141,142,143,144]. The most commonly prescribed adjuvant analgesics in our pain clinic are melatonin, lidocaine 5% patch, gabapentin, and low-dose amitriptyline (See Table 5).…”

Section: Medicationsmentioning

confidence: 99%

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

et al. 2016

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Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

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Section: Medicationsmentioning

confidence: 99%

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

et al. 2016

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“…In the study by Edwards et al, 3 6 of 8 preterm infants were started on a regimens of 10 mg/kg/d divided every 12 hours. Three infants experienced bradycardia within the first 24 hours, which resolved with lower doses in 2 of the 3.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 The goal is to optimize the dose and interval to relief of symptoms while minimizing adverse effects. Based on previous case reports, the authors recommend a starting dose of 5 to 10 mg/kg administered once daily at bedtime.…”

Section: Discussionmentioning

confidence: 99%

Visceral Hyperalgesia

Asaro

Robinson

Levy

2017

Child Neurology Open

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Visceral hyperalgesia refers to increased pain sensation in response to gastrointestinal sensory stimulus. In neonates with neurological impairments, gabapentin has been successfully used as a treatment for visceral hyperalgesia in neonates. The authors describe a preterm infant with myelomeningocele and persistent neuropathic pain that manifested as irritability, hypertonicity, poor weight gain, and feeding intolerance. After exclusion of other etiologies, the diagnosis of visceral hyperalgesia was suspected and the infant was treated with gabapentin. Following appropriate titration to effect and close monitoring of side effects of gabapentin, he subsequently demonstrated improved tone, decreased irritability with feedings, and appropriate weight gain. In addition, the authors provide a review of the available literature of gabapentin use in neonates and offer suggestions on when to consider starting gabapentin in a neonate with neurological impairment and chronic unexplained gastrointestinal manifestations. Visceral hyperalgesia refers to increased pain sensation in response to gastrointestinal sensory stimulus.1-3 In neonates with neurological impairments, visceral hyperalgesia has been described as an underlying source of neuropathic pain that manifests as irritability, hypertonicity, poor weight gain, and feeding intolerance, all common neurological and gastrointestinal symptoms of prematurity.2-6 Visceral hyperalgesia is often misdiagnosed or not even considered as an etiology.7 There are only a few case reports and case series that describe visceral hyperalgesia in neonates and its causes, diagnosis, and treatment options. [1][2][3][4][5][6] These same case reports describe the successful use of gabapentin as a treatment for visceral hyperalgesia in neonates. The mechanism of action of gabapentin, a g-aminobutyric acid analog, is thought to inhibit pain via voltage-dependent calcium ion channels in the central nervous system and relieve the neuropathic pain in response to the gastrointestinal stimulus. [7][8][9][10] In this case report, the authors present a preterm infant with a myelomeningocele treated with gabapentin for visceral hyperalgesia that manifested with irritability, hypertonicity, poor weight gain, and feeding intolerance. The authors also provide a review of the available literature of gabapentin use in neonates and offer specific recommendations on when to consider visceral hyperalgesia and start gabapentin in neonates with neurological impairment and chronic unexplained gastrointestinal manifestations. The institutional review board at Atlantic Health System approved the study. Case ReportOur patient is a male infant born via cesarean section at 29 weeks' gestational age to a 24-year-old mother for worsening

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“…Recently, gabapentin was used in the management of numerous conditions in children including insomnia associated with neurodegenerative disorders [4], post-traumatic headaches [5] and visceral hyperalgesia associated with neurologic or gastrointestinal morbidities [6]. …”

Section: Introductionmentioning

confidence: 99%

Stability of gabapentin in extemporaneously compounded oral suspensions

2017

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This study reports the stability of extemporaneously prepared gabapentin oral suspensions prepared at 100 mg/mL from bulk drug and capsules in either Oral Mix or Oral Mix SF suspending vehicles. Suspensions were packaged in amber plastic bottles and amber plastic syringes at 25°C / 60%RH for up to 90 days. Throughout the study period, the following tests were performed to evaluate the stability of the preparations: organoleptic inspection to detect homogeneity, color or odor changes; pH measurements; and gabapentin assay using a stability-indicating HPLC-UV method. As crystallization was observed at 5°C, storage at this temperature condition is not recommended. All preparations stored at 25°C / 60%RH remained stable for the whole study duration of 90 days.

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Gabapentin Use in the Neonatal Intensive Care Unit

Cited by 54 publications

References 10 publications

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Visceral Hyperalgesia

Stability of gabapentin in extemporaneously compounded oral suspensions

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