136 Effect of fentanyl boluses on cerebral oxygenation and hemodynamics in preterm infants: A prospective observational study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".