Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study

Abstract

This was a single center, retrospective cohort study designed to evaluate the association between the administration of inotropes to hypotensive very low gestational age infants (VLGAI) and prenatal and neonatal risk factors. Inpatient medical records were reviewed to identify neonates treated with inotropes (treated group) and a control group for comparison. Two hundred and twenty two (222) VLGAI (less than 32 weeks’ gestation) were included in the final analysis and were stratified based on timing of treatment with 83 infants (37.4%) and 139 infants (62.6%) in the treated and control groups, respectively. A total of 56/83 (67%) received inotropes for arterial hypotension during the first 3 days (early treatment subgroup) and 27/83 (32.5%) after 3 days of life (late-treated subgroup). Fentanyl, severe intraventricular hemorrhage (IVH), and gestational age (GA) were the risk factors most significantly associated with the need for inotrope use both during the first 3 days of life and the whole NICU stay, before and after adjustment for confounders. In conclusion, fentanyl, severe IVH, and GA are the risk factors most strongly associated with the need for inotrope treatment in VLGAI. Measures to modify these risk factors may decrease the need for cardiovascular medications and improve outcomes.

Antibiotic Analgesic-Sedative and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review

“…Overall, the results of these studies in preterm infants warrant extreme caution with the use of this morphine during key stages of brain development, especially in extremely low birth weight infants. It should be noted, though, that it is difficult to solely attribute the adverse outcomes to morphine (and other opioids), as low GA, and pre-existing arterial hypotension are also associated with IVH [84,89,[99][100][101]. Interestingly, the analgesic effectiveness of morphine in preterm neonates was questioned, as well.…”

“…Serious adverse effects of fentanyl include dose-dependent respiratory depression, chest wall rigidity, and arterial hypotension [106]. Of note, in a retrospective study involving very low gestational age infants, fentanyl was independently associated with the need for inotropes [99]. Nevertheless, the effect of fentanyl on blood pressure in neonates is still unclear.…”