Management of chronic pain in newborn infants

Vollmer, Brigitte

doi:10.1111/dmcn.14349

Cited by 3 publications

(1 citation statement)

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“…These molecules used in the newborn include topical anesthetics, such as EMLA ( Witt et al, 2016 ). Depending on the method of administration (orally or rectally) acetaminophen (paracetamol), is also used in mild to moderate procedures, such as heelsticks or circumcision, or as an antipyretic ( Witt et al, 2016 ; Carter and Brunkhorst, 2017 ; Vollmer, 2020 ). Propofol, anxiolytics/sedatives (such as barbiturate, pentobarbital), or opioids are more specially designed for the treatment of severe and prolonged pain and end-of-life pain ( Witt et al, 2016 ; Carter and Brunkhorst, 2017 ; Vollmer, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Long-Lasting Analgesia With Transdermal Fentanyl: A New Approach in Rat Neonatal Research

Dutriez-Casteloot

Emmanuelli

Wiart³

et al. 2022

Front. Pharmacol.

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Background: With advances in neonatal care, management of prolonged pain in newborns is a daily concern. In addition to ethical considerations, pain in early life would have long-term effects and consequences. However, its treatment remains inadequate. It was therefore important to develop an experimental model of long-lasting analgesia for neonatal research.Materials and Methods: Experiments were performed in six groups of rats with transdermal fentanyl 0, 3, 12, 50, 100, or 200 μg/kg/h from second postnatal day (P2) until weaning. Assessment of analgesia was carried out at P21, with behavioral scores (ranging from 0 to 3) using a 4% formalin test. Plasma levels of fentanyl were determined by UPLC/TQD at P22. Growth rate was investigated.Results: Fentanyl 100 and 200 μg/kg/h reduced scores of formalin-evoked behavioral pain. They increased time spent in pain score 0 (8 min 55 s and 6 min 34 s versus 23 s in controls) as in low pain scores 1 and 2, and decreased time in the most severe pain score 3 (19 min 56 s and 17 min 39 s versus 44 min 15 s). Fentanylemia increased in a dose-dependent manner from 50 μg/kg/h (2.36 ± 0.64 ng/ml) to 200 μg/kg/h (8.66 ± 1.80 ng/ml). Concerning growth, no difference was observed except weaker growth from P17 to P22 with 200 μg/kg/h. Clinically, we noticed no visible side effect from 3 to 100 μg/kg/h. Concomitantly, 200 μg/kg/h was responsible for ophthalmological side effects with appearance of corneal bilateral clouding in 90% pups. No difference was observed between male and female rats.Conclusion: Altogether, results indicate that transdermal fentanyl 100 μg/kg/h is an efficient therapeutic for long-lasting analgesia in lactating pups. This new model provides a useful tool for protection and welfare, and future opportunity for studying long-term health consequences of sustainable neonatal analgesia.

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