Women's and Children's Health Department, Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy.
Pediatrics, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):7764-7770. doi: 10.1080/14767058.2021.1937106. Epub 2021 Sep 5.
Therapeutic hypothermia is the standard care for asphyxiated newborns. Discomfort and pain during treatment are common and may affect therapeutic efficacy of hypothermia. Opioid analgosedation is commonly used in the clinical setting, but its effects in the cooled newborns is poorly investigated.
The aim of this study was to assess the safety of fentanyl analgosedation during therapeutic hypothermia, by evaluating severe adverse effects and possible correlation with the neurodevelopmental outcome.
We analyzed asphyxiated newborns treated with hypothermia receiving fentanyl intravenous infusion (years 2013-2018). Severe neurodevelopmental outcome was defined as cerebral palsy or Griffith's developmental quotient <70 or major sensorineural deficit. Severe brain lesions were defined as cortical or/and basal ganglia extensive involvement.
Fentanyl cumulative dose was variable (61.7 ± 18.5 µg/kg; range 34.3-120.3 µg/kg) among 45 enrolled patients. Respiratory depression was recorded in 13.3% cases of 30 spontaneously breathing patients. Severe brain lesions and severe neurodevelopmental disability were found in 24.4 and 11.1% of all included cases, respectively. Higher cumulative fentanyl dose was not associated with poor outcome.
Fentanyl treatment during therapeutic hypothermia does not negatively affect the neurodevelopmental outcome, thus on the contrary, it may contribute to ameliorate neuroprotection in the asphyxiated cooled newborns.
治疗性低温是窒息新生儿的标准治疗方法。治疗过程中的不适和疼痛很常见，可能会影响低温治疗的疗效。阿片类药物镇静在临床实践中被广泛应用，但在冷却的新生儿中其效果尚未得到充分研究。
本研究旨在评估芬太尼镇静在治疗性低温中的安全性，通过评估严重不良事件及其与神经发育结局的可能相关性。
我们分析了 2013 年至 2018 年期间接受低温治疗的窒息新生儿，他们接受了芬太尼静脉输注。严重神经发育结局定义为脑瘫或 Griffith 发育商数<70 或主要感觉神经性缺陷。严重脑损伤定义为皮质和/或基底节广泛受累。
45 名入组患者的芬太尼累积剂量（61.7±18.5 µg/kg；范围 34.3-120.3 µg/kg）存在差异。30 名自主呼吸患者中有 13.3%的患者出现呼吸抑制。所有纳入病例中，严重脑损伤和严重神经发育障碍的发生率分别为 24.4%和 11.1%。较高的芬太尼累积剂量与不良结局无关。
治疗性低温期间芬太尼治疗不会对神经发育结局产生负面影响，相反，它可能有助于改善窒息冷却新生儿的神经保护。
