Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome.
OBJECTIVE
To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome.


METHODS
Twenty premature infants undergoing mechanical ventilation for respiratory distress syndrome were randomly assigned, in a double-blind fashion, to receive fentanyl by continuous infusion or a volume-matched placebo infusion. A behavioral state score was used to assess the infants' behavior. Cortisol and 11-deoxycortisol levels were measured as physiologic markers of stress. Urinary 3-methyl histidine/creatinine molar ratio was determined and the fractional excretion of urea was measured to assess catabolic state. Ventilatory indexes were recorded for each infant.


RESULTS
Infants receiving fentanyl showed significantly lower behavioral state scores (p < 0.04) and lower heart rates (p < 0.001) than those receiving placebo. 11-Deoxycortisol levels were lower in the fentanyl group on days 3, 4, and 5 of the study (p < 0.003). 3-Methyl histidine/creatinine ratios and fractional excretion of urea were not significantly different between the two groups. On the third day of the study, infants receiving fentanyl required a higher ventilator rate (p < 0.01), higher peak inspiratory pressures (p < 0.001), and higher positive end-expiratory pressure (p < 0.0001) than those receiving placebo. There was no difference in long-term outcome with respect to the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, or sepsis or with respect to the duration of ventilator use.


CONCLUSIONS
Although there was a reduction in stress markers in the infants receiving fentanyl, we were unable to demonstrate an improvement in catabolic state or long-term outcome. In addition, the infants receiving fentanyl required higher ventilatory support in the early phase of respiratory distress syndrome than did those receiving placebo.
Orsini
A J
AJ
Division of Neonatology, Jefferson Medical College, Philadelphia, USA.
Leef
K H
KH
Costarino
A
A
Dettorre
M D
MD
Stefano
J L
JL
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004311:Double-Blind Method; D005283:Fentanyl / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D018730:Infant Behavior / Q000187:drug effects; D007231:Infant, Newborn; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D013312:Stress, Physiological / Q000517:prevention & control*; D016896:Treatment Outcome; D015300:Ventilator Weaning
D000701:Analgesics, Opioid; D005283:Fentanyl