[OPIATES USE IN VERY-LOW-BIRTH-WEIGHT INFANTS--CALL FOR CAUTION]

Abstract

Background: Very-low-birth-weight (VLBW) infants are occasionally treated with opiates for sedation and pain relief.

Objective: To study the short term outcomes of VLBW infants treated with opiates.

Methods: We conducted a retrospective study of all VLBW infants born during the period 2006-2010; 45 were treated with opiates (41 fentanyl continuous IV drip and 4 IV morphine prn); 114 served as controls.

Results: In the univariate analysis, VLBW infants treated by opiates had significantly lower Gestational Age (GA) (28.3 ± 2.4 vs. 30.3 ± 2.1 weeks) and BW (1012 ± 299 vs. 1204 ± 219 grams] and required longer periods of ventilatory support (30.3 ± 21.0 vs. 7.7 ± 12.0 days) and oxygen supplementation (40.4 ± 40.3 vs. 7.7 ± 17.3 days). They had significantly more intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), late onset infections, necrotizing enterocolitis (NEC and bronchopulmonary dysplasia (BPD). Time to reach full enteral (32.5 ± 22.1 vs. 15.6 ± 6.1 days) and full oral (64.6 ± 25.0 vs. 42.0 ± 20.7 days) feedings and length of stay (89.6 ± 37.1 vs. 53.7 ± 20.8 days) were significantly longer. In multivariate analysis, after controlling for GA and BW, opiates remained significantly associated only with PDA and longer ventilatory support and time to full enteral feeding.

Conclusion: The use of opiates in VLBW infants may be associated with short term morbidities. Thus, opiates should be used with caution in this age group, and alternative approaches for sedation or pain relief should be considered. Randomized controlled studies are warranted to support our findings.