136 Effect of fentanyl boluses on cerebral oxygenation and hemodynamics in preterm infants: A prospective observational study
Notice bibliographique
Résumé
Fentanyl, an opioid analgesic, is one of the most commonly used off-label medications for pain control and sedation in preterm infants. However, there is a growing concern with the link between fentanyl use and poor neurodevelopmental outcomes in preterm infants. Animal studies have shown that fentanyl infusion significantly reduces cerebral oxygenation in newborn piglets. Yet the effect of this medication on cerebral perfusion in preterm neonates remains unexplored. To evaluate the effect of a bolus dose of fentanyl on the regional cerebral oxygen saturation (RcSO2), cerebral fractional tissue oxygen extraction (cFTOE) and cardiac (left ventricular) output (LVO) as compared with pre-administration baseline in preterm infants. This was a prospective observational study conducted in a level III Canadian NICU from October 2017 to October 2018. Infants born <37 weeks of gestation and scheduled to receive a bolus dose of fentanyl (1-2microgram/kg/dose) were eligible. Infants with major congenital anomalies, medically unstable infants and those who had received fentanyl bolus in the previous 48 hours were excluded. Once enrolled in the study following parental written informed consent, cerebral oximetry monitoring using near-infrared spectroscopy (INVOSTM 5100c) was started 15 minutes prior to the fentanyl bolus and continued for 6 hours post fentanyl administration. Simultaneously, the cardiac output was measured using a non-invasive doppler ultrasound (USCOMTM) at 5 mins prior and at 5, 15, 30 mins and 6 hours post fentanyl bolus. The primary outcome was difference between RcSO2 measured 5 mins prior to and RcSO2 measured at the above-mentioned time points post-fentanyl administration. This research was approved by the institutional Research Ethics Board. 29 infants were enrolled during the study period [Median gestational age 28 weeks; Interquartile range (IQR) 25–30 weeks; median birth weight 1020 g (IQR 830–1275 g); median postnatal age 4 days (IQR 2.5–7.5 days)]. 28 infants received fentanyl for peripherally inserted central catheter placement and one received fentanyl for endotracheal intubation. Baseline mean (± standard deviation) RcSO2 was 72.8% (±11.4%), CFTOE was 21.9 (±11.2) and LVO was 0.38 (±0.15) L/min prior to fentanyl infusion. Figure 1 shows the boxplot of RcSO2 values pre- and post-fentanyl administration. One-way ANOVA showed no statistically significant difference between baseline and any of the post-fentanyl cerebral oxygenation or hemodynamic measures (p>0.05). (Table 1). Administration of fentanyl bolus for procedural pain and sedation in preterm infants does not appear to affect cerebral oxygenation, cerebral tissue oxygen extraction and cardiac output in preterm infants. Further follow-up studies are required to evaluate the effect of cumulative doses of fentanyl on cerebral perfusion in the short term and neurodevelopmental outcomes in the longer term.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».