title: Use of analgesic and sedative drugs in VLBW infants in German NICUs from 2003-2010.
abstract: Very low birth weight (VLBW) infants frequently receive analgesia and/or sedation for painful procedures and mechanical ventilation to avoid negative stress. Yet, concerns remain regarding potential adverse long-term effects of these drugs on VLBW infants' neurocognitive outcome. Recent studies have shown that less invasive surfactant application (LISA) and early nasal CPAP treatment reduce the need for mechanical ventilation and painful procedures. Therefore, these measures might also reduce the application of analgesic and/or sedative drugs in VLBW infants. To evaluate this hypothesis and to identify potential changes in analgesic treatment concepts in recent years, we retrospectively analyzed data on analgesia and sedation, respiratory support, and the method of surfactant application in VLBW infants enrolled in the German Neonatal Network (GNN) trial between 2003 and 2009 (period 1) and compared it with data from infants participating in GNN in 2010 (period 2). In both periods, about one third of all infants were treated with analgesic and/or sedative drugs using a wide variety of substances. The administration of novel drugs such as propofol, sufentanil, or intravenous paracetamol was higher in 2010 (6.7 vs. 12.2 %). Infants who were treated with CPAP only received significantly less analgesic/sedative medication than infants who were mechanically ventilated (12 vs. 65 %, p=<0.001). Similarly, infants treated with LISA received less analgesic or sedative drugs as compared to infants who received surfactant via endotracheal intubation (36 vs. 63 %, p=0.001).
  
  
  CONCLUSIONS
  Although both avoidances of mechanical ventilation and less invasive surfactant application are associated with reduced analgesic or sedative treatment, the percentage of VLBW infants who received analgesia and/or sedation remained unchanged in Germany in recent years.
authors.affiliation: Department of Neonatology, Children's Hospital, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany, katrin.mehler@uk-koeln.de.
authors.forename: Katrin
authors.initials: K
authors.lastname: Mehler
authors.forename: André
authors.initials: A
authors.lastname: Oberthuer
authors.forename: Christoph
authors.initials: C
authors.lastname: Haertel
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.forename: Bernd
authors.initials: B
authors.lastname: Roth
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Goepel
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005260:Female; D005858:Germany; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D011663:Pulmonary Surfactants