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Opioid and benzodiazepine use during therapeutic hypothermia in encephalopathic neonates

Journal of Perinatology volume 40, pages 79–88 (2020)Cite this article

Subjects

Abstract

Objectives

To evaluate the use of sedatives and analgesics during therapeutic hypothermia in encephalopathic neonates and assess associations between medication exposure and hospital outcomes.

Study design

We identified neonates ≥35 weeks gestational age treated with therapeutic hypothermia at 125 neonatal intensive care units between 2007 and 2015. We compared characteristics and hospital outcomes between unexposed neonates and neonates exposed to opioids and/or benzodiazepines.

Results

Opioids were administered to 1 677/2 621 (64%) neonates, and exposure increased from 38% in 2008 to 68% in 2015. Sedation/analgesia varied widely between centers. Opioid-exposed neonates experienced greater durations of respiratory support and were more likely to receive inotropes and inhaled nitric oxide. Mortality during postnatal days 0–3 was lower among opioid-exposed neonates (31/625 [5%]) than unexposed neonates (64/714 [9%]).

Conclusions

Sedation/analgesia during therapeutic hypothermia is prevalent but not uniform across centers. Prospective studies are needed to assess if exposure independently predicts intensity and duration of physiologic support.

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Funding

Our manuscript represents original work, is not under consideration for publication elsewhere, and has not been previously published, except in abstract form at the Pediatric Academic Societies annual meetings in 2017 (between center variation) and 2018 (outcome comparisons). This study was not financially supported or sponsored. MWB composed the first draft of the manuscript. No honorarium, grant, or other form of payment was provided to any author in exchange for producing the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Megan W. Berube

  2. Department of Pediatrics, Duke University, Durham, NC, USA

    Megan W. Berube, Monica E. Lemmon, Carolyn E. Pizoli, Margarita Bidegain, C. Michael Cotten & Rachel G. Greenberg

  3. Duke-Margolis Center for Health Policy, Durham, NC, USA

    Monica E. Lemmon

  4. Johns Hopkins Hospital, Baltimore, MD, USA

    Monica E. Lemmon

  5. Center for Research, Education, Quality and Safety, MEDNAX Inc, Sunrise, FL, USA

    Veeral N. Tolia

  6. Duke Clinical Research Institute, Durham, NC, USA

    Rachel G. Greenberg

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Corresponding author

Correspondence to Megan W. Berube.

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Conflict of interest

RCG has received support from industry for research services (https://dcri.org/about-us/conflict-of-interest/). MEL receives funding from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (K12NS098482) and the Derfner Foundation. CMC receives funding for work related to interventions for hypoxic-ischemic encephalopathy from the Eunice Kennedy Shriver NICHD Neonatal Research Network Grant: 5U10 HD040492-10, and the Duke National Center for Advancing Translational Sciences (NCATS) 1UL1-TR002553. MWB, MB, CEP, and VNT declare that they have no conflict of interest.

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Berube, M.W., Lemmon, M.E., Pizoli, C.E. et al. Opioid and benzodiazepine use during therapeutic hypothermia in encephalopathic neonates. J Perinatol 40, 79–88 (2020). https://doi.org/10.1038/s41372-019-0533-4

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