title: Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants.
abstract: To characterize administration of sedatives, analgesics, and paralytics in a large cohort of mechanically ventilated premature infants.
  
  
  
  Retrospective cohort study including all infants <1500 g birth weight and <32 weeks gestational age (GA) mechanically ventilated at 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. The primary outcome is the proportion of mechanically ventilated days in which infants were administered drugs of interest. Multivariable logistic regression was used to evaluate the predictors of administration of drugs of interest.
  
  
  
  We identified 85 911 mechanically ventilated infants. Infants received a drug of interest (opioids, benzodiazepines, other sedatives, and paralytics) on 433 587/1 305 413 (33%) of mechanically ventilated infant days. The administration of opioids increased during the study period from 5% of infant days in 1997 to 32% in 2012. The administration of benzodiazepines increased during the study period from 5% of infant days in 1997 to 24% in 2012. Use of paralytics and other drugs remained ≤1% throughout the study period. Predictors of drug administration included younger GA, small for GA status, male sex, presence of a major congenital anomaly, older postnatal age at intubation, exposure to high-frequency ventilation, exposure to inotropes, more recent year of discharge, and neonatal intensive care unit site.
  
  
  
  Administration of opioids and benzodiazepines in mechanically ventilated premature infants increased over time. Because infant characteristics were unchanged, site-specific differences in practice likely explain our observations. Increased administration over time is concerning given limited evidence of benefit and potential for harm.
authors: Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC.
authors: Kanecia O
authors: KO
authors: Zimmerman
authors: Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC.
authors: P Brian
authors: PB
authors: Smith
authors: Department of Economics, Clemson University, Clemson, SC.
authors: Daniel K
authors: DK
authors: Benjamin
authors: Department of Pediatrics, Division of Neonatology, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Matthew
authors: M
authors: Laughon
authors: Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL.
authors: Reese
authors: R
authors: Clark
authors: Department of Pediatrics, Division of Critical Care Medicine, Weill Cornell Medical College, New York, NY.
authors: Chani
authors: C
authors: Traube
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Til
authors: T
authors: Stürmer
authors: Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC. Electronic address: christoph.hornik@dm.duke.edu.
authors: Christoph P
authors: CP
authors: Hornik
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D059408:Pain Management; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents
keywords: comfort drugs; ventilated infants