Physiological, hormonal, and behavioral responses to a single fentanyl dose in intubated and ventilated preterm neonates.
OBJECTIVE
To study the responses of ventilated preterm neonates to a single dose of opioid.


METHODS
In a randomized, double-blind, controlled trial, 22 mechanically ventilated preterm infants (< or = 32 weeks) were observed before medication and at 30 and 60 minutes after administration of fentanyl (3 micrograms/kg) or placebo. Heart rate, blood pressure, arterial blood gases, ventilator settings, and behavioral measures (Neonatal Facial Coding System and Modified Postoperative Comfort Score) were recorded during each period. Blood cortisol, growth hormone, glucose, and lactate were measured before and at 60 minutes after analgesia. Behavioral measures were assessed at the bedside and from video films recorded during each observation period.


RESULTS
Patients presented high basal levels of cortisol, growth hormone, and lactate. Behavioral scales indicated the presence of pain before any medication. In the fentanyl group, the maximum and minimum heart rate decreased and growth hormone level increased after analgesia. At the video analysis of behavioral measures, postoperative comfort score increased and neonatal facial coding system score decreased in the fentanyl group.


CONCLUSIONS
Single doses of fentanyl analgesia can reduce the physiologic/behavioral measures of pain and stress associated with mechanical ventilation in preterm infants.
Guinsburg
R
R
Department of Pediatrics, Federal University of São Paulo/Escola Paulista de Medicina, Brazil.
Kopelman
B I
BI
Anand
K J
KJ
de Almeida
M F
MF
Peres
C de A
Cde A
Miyoshi
M H
MH
D000698:Analgesia; D000701:Analgesics, Opioid; D001786:Blood Glucose / Q000032:analysis; D002405:Catheterization, Central Venous; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006439:Hemodynamics; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007442:Intubation, Intratracheal; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010146:Pain / Q000503:physiopathology* / Q000517:prevention & control; D010147:Pain Measurement; D012121:Respiration, Artificial; D013997:Time Factors
D000701:Analgesics, Opioid; D001786:Blood Glucose; D019382:Human Growth Hormone; D019344:Lactic Acid; D005283:Fentanyl; D006854:Hydrocortisone