Narcotics and Sedative Use in Preterm Neonates.
To evaluate patterns of narcotic and sedative use in neonatal intensive care units (NICUs) across Canada using data collected by the Canadian Neonatal Network.



We conducted a retrospective observational cohort study of preterm neonates at <33 weeks' gestation and admitted to a participating Canadian Neonatal Network NICU. The proportion of all neonates who received sedative(s), narcotic(s), or either sedative(s), narcotic(s), or both during their NICU stay was calculated for each year. Because opioids are used for premedication before intubation, only continuous infusions of a narcotic drug were included. Variation in narcotics and sedative usage between sites in 2014 was determined using logistic regression analysis, with adjustment for gestational age, surgery, and mechanical ventilation.



Of 20 744 neonates, 29% of neonates received a narcotic, a sedative, or both; 23% received a narcotic and 17% a sedative. Although no clinically significant changes in drug exposure were documented during the 5-year period, there were statistically significant differences in narcotic and sedative use between sites, ranging from 3% to 41% for narcotic and 2% to 48% for sedative use (aORs 0.2-5.7 and 0.1-15, respectively, P < .05).



Exposure to narcotic or sedative agents is highly variable in preterm neonates across Canada despite concerns of adverse outcomes associated with these drugs. The tremendous variation in practice suggests that further research on their current usage, as well as identifying optimal practice procedures is warranted.
British Columbia's Women's Hospital and Health Center, Vancouver, British Columbia, Canada.
Liron
L
Borenstein-Levin
British Columbia's Women's Hospital and Health Center, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada. Electronic address: asynnes@cw.bc.ca.
Anne
A
Synnes
British Columbia's Women's Hospital and Health Center, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada.
Ruth E
RE
Grunau
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Steven P
SP
Miller
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Eugene W
EW
Yoon
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Prakesh S
PS
Shah
D002170:Canada; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D009294:Narcotics / Q000627:therapeutic use*; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D009294:Narcotics
Morphine; Narcotics; Preterm neonates; Sedatives