Resolution of opioid-induced postoperative ileus in a newborn infant after methylnaltrexone

Garten, Lars; Degenhardt, P.; Bührer, Christoph

doi:10.1016/j.jpedsurg.2010.10.015

Cited by 27 publications

(24 citation statements)

References 11 publications

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“…In another case reported by Garten and colleagues, a newborn infant had postoperative ileus for 8 days, and intestinal dysmotility was resolved within 15 minutes of intravenous methylnaltrexone administration. 6 These cases demonstrate not only that methylnaltrexone has been successful in pediatric patients but also that its onset of action is extremely rapid.…”

Section: Discussionmentioning

confidence: 90%

Methylnaltrexone Use in a Seventeen-Month-Old Female with Progressive Cancer and Rectal Prolapse

Laubisch

Baker²

2013

Journal of Palliative Medicine

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Background: Opioid-induced constipation is commonly seen in pediatrics, especially at the end of life. As patients clinically decline, constipation often leads to increased pain and distress, while its enteral treatment becomes more challenging. Method: There is little information about the safety and use of methylnaltrexone in children. We present the case of a 17-month-old girl with progressive leukemia who was at the end of her life and whose severe opioidinduced constipation and rectal prolapse was successfully treated with the l-opioid-receptor antagonist methylnaltrexone. We selected a lower dose based on our lack of experience with methylnaltrexone in this age group and concern for potential complications given her rectal prolapse. Discussion: Opioid-induced constipation, abdominal distention, and rectal prolapse caused our patient's most distressing symptoms, even in the context of advanced cancer. A single dose of subcutaneous methylnaltrexone (0.12 mg/kg) resolved her constipation and rectal prolapse within one hour. Although evidence is limited, the drug has successfully been used in pediatric patients with no reported side effects to date. We recommend its use earlier in the course of severe opioid-induced constipation in children unable to tolerate an oral laxation regimen. Prospective research is needed to establish the parameters for use of this effective agent in children who cannot tolerate other regimens.

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Section: Discussionmentioning

confidence: 90%

Methylnaltrexone Use in a Seventeen-Month-Old Female with Progressive Cancer and Rectal Prolapse

Laubisch

Baker²

2013

Journal of Palliative Medicine

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“…The intravenous route has been shown to be safe in adults,1 4 and there are isolated reports of intravenous methylnaltrexone use in neonates with opioid-induced ileus or urinary retention 5 6. Enteral and subcutaneous use has been described in paediatric patients with severe opioid-induced constipation 7 8.…”

Section: Discussionmentioning

confidence: 99%

Paediatric palliative care: intravenous methylnaltrexone relieves constipation

Yeomanson

Chohan

Mayer³

2012

BMJ Support Palliat Care

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Methylnaltrexone, a peripheral opioid μ-receptor antagonist is licensed for subcutaneous administration for the treatment of severe opioid-induced constipation in adults. We describe the use of intravenous methylnaltrexone in a 3-year-old boy receiving a subcutaneous diamorphine infusion for palliation from widely metastatic alveolar rhabdomyosarcoma. The patient, who had not opened his bowels for 3 weeks despite use of regular conventional laxatives, was given a 150 mcg/kg dose via indwelling central venous catheter. Constipation was relieved within minutes of the injection. There were no side effects noted during or following injection, and no clinically apparent reduction in analgesia. Intravenous methylnaltrexone may provide a valuable additional treatment option in paediatric palliative care, especially for those with an oncological diagnosis, the majority of whom will have indwelling central venous access devices.

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“…A case report of the use of methylnaltrexone to treat postoperative ileus in a neonate demonstrated success in restoring bowel motility 15 min after a 0.15 mg/kg IV infusion [ 133 ]. The infant had undergone two separate exploratory laparoscopies for necrotizing enterocolitis and was on a fentanyl drip for pain control.…”

Section: Methylnaltrexonementioning

confidence: 99%