Cui Yu, Tang Min, Mu Qixia, Wu Qunying, Kang Lu, Chen Qin, He Yani
Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's and Children's Central Hospital, Chengdu, China.
Front Pharmacol. 2024 Jul 26;15:1381413. doi: 10.3389/fphar.2024.1381413. eCollection 2024.
Newborns and small infants are unable to cooperate actively during diagnostic procedures; therefore, sedation is often employee to maintain immobilization and obtain high-quality images. However, these procedures are often indicated in sick, vulnerable, or hemodynamically unstable neonates and young infants, which raises the associated risks of sedation. This study summarizes our 4-year of experience with safe and effective procedural sedation in this vulnerable population.
This retrospective study analyzed data on neonates and young infants who underwent non-painful diagnostic procedures from December 2019 to November 2023. Patients were categorized into the neonate (aged≦ 28 days) and the young infant (29 days ≦ aged ≦ 90 days) groups.
Non-pharmacological strategies, including sleeping naturally, swaddling/facilitated tucking, non-nutritive sucking, and skin-to-skin care, can achieve a success rate for sedation about 98.4%. In terms of pharmacological methods, our institution primarily utilizes chloral hydrate for procedural sedation in neonates and young infants undergoing non-painful diagnostic procedures. Midazolam serves as an alternative sedative. Chloral hydrate alone demonstrated a 92.5% success rate on the first attempt, compared to midazolam alone, with an 85.11% success rate. Neonates experienced a higher incidence of adverse events during sedation compared to young infants.
This study reviews our 4-year experience with procedural sedation in neonates and young infants. Chloral hydrate demonstrated a high degree of safety and efficacy in this population. However, supervision by skilled medical personnel and extended observation is required. In our institution, the experience with midazolam is limited in this population, and further research is warranted to establish its safety and efficacy. Non-pharmacological strategies can achieve an acceptable rate of sedation success, which can be used based on patient's tolerance.
新生儿和小婴儿在诊断程序中无法积极配合；因此，镇静剂常被用于保持其不动并获取高质量图像。然而，这些程序常用于患病、脆弱或血流动力学不稳定的新生儿和小婴儿，这增加了镇静的相关风险。本研究总结了我们在这一脆弱人群中进行安全有效的程序性镇静的4年经验。
这项回顾性研究分析了2019年12月至2023年11月期间接受非痛苦诊断程序的新生儿和小婴儿的数据。患者被分为新生儿组（年龄≤28天）和小婴儿组（29天≤年龄≤90天）。
非药物策略，包括自然睡眠、包裹/辅助包裹、非营养性吸吮和皮肤接触护理，可使镇静成功率达到约98.4%。在药物方法方面，我们机构主要使用水合氯醛对接受非痛苦诊断程序的新生儿和小婴儿进行程序性镇静。咪达唑仑作为替代镇静剂。单独使用水合氯醛首次尝试的成功率为92.5%，而单独使用咪达唑仑的成功率为85.11%。与小婴儿相比，新生儿在镇静期间不良事件的发生率更高。
本研究回顾了我们在新生儿和小婴儿程序性镇静方面的4年经验。水合氯醛在这一人群中显示出高度的安全性和有效性。然而，需要熟练的医务人员进行监督并延长观察时间。在我们机构，咪达唑仑在这一人群中的经验有限，需要进一步研究以确定其安全性和有效性。非药物策略可达到可接受的镇静成功率，可根据患者的耐受性使用。
