Abstract 1172

Objective: identify factors that may contribute to opioid use in intubated newborn infants (NB).

Method: from 1/95-6/97, all intubated and ventilated for more than 60 minutes NB were studied. At this time, pain scales were not used in the NICU. Patients were divided in two groups: NB that did not receive analgesia (n=80, BW 1280g, variation 560-3670g, GA 33±3 wk, 38% male), and NB that received ≥ 1 opioid dose (n=97, BW 1460g, variation 580-3890g, GA 33±4 wk, 63% male). The following variables were collected: demographic data, neonatal diseases, and daily number of invasive procedures. Factors implied with analgesic use were studied by univariate analysis and logistic regression.

Results: significant differences between groups (p<0.05) detected by univariate analysis were:

Without Analgesia: 34% had RDS, 6% airleaks, 21% PDA, 36% sepsis, 3% NEC, 19% IVH, and 21% died. At start of ventilation, the median oxygenation index (OI) was 5% (variation 0-50%). During ventilation, 5% of patients had chest tubes, the mean number of intubations was 1.3±0.5, and the daily mean number of punctures per patient was: arterial 5±2, capillary 4±2, and venous 2±1. NB were ventilated for 2 days (0-30 days).

With Analgesia: 51% had RDS, 18% airleaks, 6% PDA, 23% sepsis, 10% NEC, 6% IVH, and 50% died. At start of ventilation, the median OI was 9% (variation 1-116%). During ventilation, 23% of patients had chest tubes, the mean number of intubations was 1.9±1.6, and the daily mean number of punctures per patient was: arterial 3±2, capillary 2±2, and venous 1±1. NB were ventilated for 4 days (0-61 days).

Logistic regression showed that the use of ≥ 1 dose of opioid was positively associated with presence of RDS, higher OI at start of ventilation, and presence of chest tubes. Analgesic use was negatively associated with the number of punctures, and with PDA presence. Opioid use was independent of year of birth, birthweight, and gestational age.

Conclusion: opioid use in intubated newborn infants was related to the severity of respiratory disease. Currently, little attention is given to the number of painful procedures performed in each patient. Pain scales should be incorporated in the clinical setting in order to adequately treat the neonatal pain.