title: Withdrawal syndrome in the pediatric intensive care unit. Incidence and risk factors.
abstract: OBJECTIVE
  To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors.
  
  
  METHODS
  Historic or retrospective cohort study.
  
  
  METHODS
  Pediatric Intensive Care Unit in an academic center.
  
  
  METHODS
  Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48 hours.
  
  
  METHODS
  None.
  
  
  METHODS
  Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome.
  
  
  RESULTS
  Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48 mg/kg, a cumulative midazolam dose of 40 mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36 hours after weaning from infusion. Methadone was used in most cases for treating withdrawal.
  
  
  CONCLUSIONS
  There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome.
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario de Salamanca, Salamanca, Spain. pacojum@gmail.com
authors.forename: F
authors.initials: F
authors.lastname: Fernández-Carrión
authors.forename: M
authors.initials: M
authors.lastname: Gaboli
authors.forename: R
authors.initials: R
authors.lastname: González-Celador
authors.forename: P
authors.initials: P
authors.lastname: Gómez de Quero-Masía
authors.forename: S
authors.initials: S
authors.lastname: Fernández-de Miguel
authors.forename: V
authors.initials: V
authors.lastname: Murga-Herrera
authors.forename: O
authors.initials: O
authors.lastname: Serrano-Ayestarán
authors.forename: J M
authors.initials: JM
authors.lastname: Sánchez-Granados
authors.forename: R
authors.initials: R
authors.lastname: Payo-Pérez
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008874:Midazolam / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl