Opioid withdrawal in critically ill neonates.
OBJECTIVE
To determine the occurrence of and risk factors for opioid withdrawal in critically ill neonates receiving continuous infusions of fentanyl.


METHODS
A prospective interventional cohort study was conducted in a university hospital neonatal intensive care unit with 19 neonates who received a minimum of 24 hours of fentanyl by continuous infusion.


METHODS
Fentanyl total dose, duration of infusion, and peak infusion rate were recorded. Patients were evaluated for withdrawal using the Neonatal Abstinence Scoring System of Finnegan. Patients with a score >/=8 were considered to have opioid withdrawal.


RESULTS
Withdrawal was observed in 10 (53%) of 19 neonates. The fentanyl total dose (median 525 vs. 168 micro g/kg, respectively; p = 0.03) and infusion duration (median 10 vs. 7 d, respectively; p = 0.04) were significantly greater in neonates with withdrawal compared to those without withdrawal. A fentanyl total dose >/=415 micro g/kg predicted withdrawal with 70% sensitivity and 78% specificity. A fentanyl infusion duration >/=8 days predicted withdrawal with 90% sensitivity and 67% specificity. The most frequent symptoms of withdrawal were sleeping <3 hours after feeding (81%) and increased muscle tone (55%). In all neonates with withdrawal, onset occurred within 24 hours of fentanyl discontinuation.


CONCLUSIONS
Opioid withdrawal occurs frequently in critically ill neonates who receive continuous infusions of fentanyl. Longer infusion duration and higher total dose were associated with withdrawal symptoms.
Dominguez
Karen D
KD
College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. kdominguez@salud.unm.edu
Lomako
Dawn M
DM
Katz
Robert W
RW
Kelly
H William
HW
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009129:Muscle Tonus / Q000187:drug effects; D012680:Sensitivity and Specificity; D012893:Sleep Wake Disorders / Q000139:chemically induced; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*
D000701:Analgesics, Opioid; D005283:Fentanyl