35 Prescribing behavior of analgosedatives for extremely premature neonates: a retrospective analysis

• Published in: BMJ paediatrics open 2024-08, Vol.8 (Suppl 6), p.A17-A17
• Main Authors: Abdouni, Samir El, van den Bosch, GE, van Rosse, F, Simons, SHP, Flint, RB
• Format: Article
• Language: English
• Subjects: Analgesics; Fentanyl; I) Posters; Morphine; Newborn babies; Pediatrics
• ISSN: 2399-9772
• DOI: 10.1136/bmjpo-2024-ESDPPP.35

IntroductionManaging pain in extremely premature (EP) neonates is complex, and protocols at institutions often lack tailored advice for different indications or patient characteristics, increasing the risk of inadequate pain management. This study aims to examine clinician prescribing behavior, identify areas for improvement, and suggest modifications to existing protocols, which enables the improvement of analgosedative therapy for EP neonates.MethodologyIn this single center, retrospective study, we analyzed data from all EP neonates admitted to our NICU between 2017 and 2021, comparing baseline characteristics and drug administration data.ResultsOf the 2633 neonates admitted to the NICU, 10.2% (n=268) was EP at the time of admission. Of these, 53.4% (n=143) received analgosedative therapy. ‘Pain’ was the most common therapeutic indication (51.8%). Morphine, fentanyl, and acetaminophen were prescribed to more than half of the patients. Over 90% of patients received their analgosedative drugs exclusively intravenously (IV). Morphine and midazolam were mainly administered via continuous infusion, while fentanyl and acetaminophen were mostly given as bolus. During the initiation of continuous infusion, loading doses were administered for morphine and midazolam in 67.6% and 58.6% of cases, respectively. At dose escalation, these percentages decreased to 39.8% and 33.3% for morphine and midazolam, respectively. Morphine continuous infusion patients who always received a loading dose required a lower median dosage at 24 hours (5.0 mg/kg/hr) than those who didn’t (11.0 mg/kg/hr). This trend was not observed for midazolam (see table 1).ConclusionThe observed higher dosages required by EP neonates who did not receive a loading dose highlights the need for a critical evaluation of the use of loading doses during the initiation and dose escalation of continuous infusions, with the aim of reducing pain in this vulnerable population.