Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome

A. J. Orsini, K. H. Leef, A. Costarino, Michael Dettorre, J. L. Stefano

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Objective: To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome. Methods: Twenty premature infants undergoing mechanical ventilation for respiratory distress syndrome were randomly assigned, in a double-blind fashion, to receive fentanyl by continuous infusion or a volume-matched placebo infusion. A behavioral state score was used to assess the infants' behavior. Cortisol and 11-deoxycortisol levels were measured as physiologic markers of stress. Urinary 3-methyl histidine/creatinine molar ratio was determined and the fractional excretion of urea was measured to assess catabolic state. Ventilatory indexes were recorded for each infant. Results: Infants receiving fentanyl showed significantly lower behavioral state scores (p <0.04) and lower heart rates (p <0.001) than those receiving placebo. 11 -Deoxycortisol levels were lower in the fentanyl group on days 3, 4, and 5 of the study (p <0.003). 3-Methyl histidine/creatinine ratios and fractional excretion of urea were not significantly different between the two groups. On the third day of the study, infants receiving fentanyl required a higher ventilator rate (p <0.01), higher peak inspiratory pressures (p <0.001), and higher positive end-expiratory pressure (p <0.0001) than those receiving placebo. There was no difference in long-term outcome with respect to the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, or sepsis or with respect to the duration of ventilator use. Conclusions: Although there was a reduction in stress markers in the infants receiving fentanyl, we were unable to demonstrate an improvement in catabolic state or long-term outcome. In addition, the infants receiving fentanyl required higher ventilatory support in the early phase of respiratory distress syndrome than did those receiving placebo.

Original languageEnglish (US)
Pages (from-to)140-145
Number of pages6
JournalJournal of Pediatrics
Volume129
Issue number1
DOIs
StatePublished - Jan 1 1996

Fingerprint

Newborn Respiratory Distress Syndrome
Fentanyl
Pain
Placebos
Cortodoxone
Mechanical Ventilators
Histidine
Premature Infants
Urea
Creatinine
Infant Behavior
Bronchopulmonary Dysplasia
Positive-Pressure Respiration
Artificial Respiration
Hydrocortisone
Sepsis
Heart Rate
Hemorrhage
Pressure
Incidence

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Orsini, A. J. ; Leef, K. H. ; Costarino, A. ; Dettorre, Michael ; Stefano, J. L. / Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome. In: Journal of Pediatrics. 1996 ; Vol. 129, No. 1. pp. 140-145.
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abstract = "Objective: To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome. Methods: Twenty premature infants undergoing mechanical ventilation for respiratory distress syndrome were randomly assigned, in a double-blind fashion, to receive fentanyl by continuous infusion or a volume-matched placebo infusion. A behavioral state score was used to assess the infants' behavior. Cortisol and 11-deoxycortisol levels were measured as physiologic markers of stress. Urinary 3-methyl histidine/creatinine molar ratio was determined and the fractional excretion of urea was measured to assess catabolic state. Ventilatory indexes were recorded for each infant. Results: Infants receiving fentanyl showed significantly lower behavioral state scores (p <0.04) and lower heart rates (p <0.001) than those receiving placebo. 11 -Deoxycortisol levels were lower in the fentanyl group on days 3, 4, and 5 of the study (p <0.003). 3-Methyl histidine/creatinine ratios and fractional excretion of urea were not significantly different between the two groups. On the third day of the study, infants receiving fentanyl required a higher ventilator rate (p <0.01), higher peak inspiratory pressures (p <0.001), and higher positive end-expiratory pressure (p <0.0001) than those receiving placebo. There was no difference in long-term outcome with respect to the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, or sepsis or with respect to the duration of ventilator use. Conclusions: Although there was a reduction in stress markers in the infants receiving fentanyl, we were unable to demonstrate an improvement in catabolic state or long-term outcome. In addition, the infants receiving fentanyl required higher ventilatory support in the early phase of respiratory distress syndrome than did those receiving placebo.",
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Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome. / Orsini, A. J.; Leef, K. H.; Costarino, A.; Dettorre, Michael; Stefano, J. L.

In: Journal of Pediatrics, Vol. 129, No. 1, 01.01.1996, p. 140-145.

Research output: Contribution to journalArticle

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T1 - Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome

AU - Orsini, A. J.

AU - Leef, K. H.

AU - Costarino, A.

AU - Dettorre, Michael

AU - Stefano, J. L.

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N2 - Objective: To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome. Methods: Twenty premature infants undergoing mechanical ventilation for respiratory distress syndrome were randomly assigned, in a double-blind fashion, to receive fentanyl by continuous infusion or a volume-matched placebo infusion. A behavioral state score was used to assess the infants' behavior. Cortisol and 11-deoxycortisol levels were measured as physiologic markers of stress. Urinary 3-methyl histidine/creatinine molar ratio was determined and the fractional excretion of urea was measured to assess catabolic state. Ventilatory indexes were recorded for each infant. Results: Infants receiving fentanyl showed significantly lower behavioral state scores (p <0.04) and lower heart rates (p <0.001) than those receiving placebo. 11 -Deoxycortisol levels were lower in the fentanyl group on days 3, 4, and 5 of the study (p <0.003). 3-Methyl histidine/creatinine ratios and fractional excretion of urea were not significantly different between the two groups. On the third day of the study, infants receiving fentanyl required a higher ventilator rate (p <0.01), higher peak inspiratory pressures (p <0.001), and higher positive end-expiratory pressure (p <0.0001) than those receiving placebo. There was no difference in long-term outcome with respect to the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, or sepsis or with respect to the duration of ventilator use. Conclusions: Although there was a reduction in stress markers in the infants receiving fentanyl, we were unable to demonstrate an improvement in catabolic state or long-term outcome. In addition, the infants receiving fentanyl required higher ventilatory support in the early phase of respiratory distress syndrome than did those receiving placebo.

AB - Objective: To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve long- and short-term outcome. Methods: Twenty premature infants undergoing mechanical ventilation for respiratory distress syndrome were randomly assigned, in a double-blind fashion, to receive fentanyl by continuous infusion or a volume-matched placebo infusion. A behavioral state score was used to assess the infants' behavior. Cortisol and 11-deoxycortisol levels were measured as physiologic markers of stress. Urinary 3-methyl histidine/creatinine molar ratio was determined and the fractional excretion of urea was measured to assess catabolic state. Ventilatory indexes were recorded for each infant. Results: Infants receiving fentanyl showed significantly lower behavioral state scores (p <0.04) and lower heart rates (p <0.001) than those receiving placebo. 11 -Deoxycortisol levels were lower in the fentanyl group on days 3, 4, and 5 of the study (p <0.003). 3-Methyl histidine/creatinine ratios and fractional excretion of urea were not significantly different between the two groups. On the third day of the study, infants receiving fentanyl required a higher ventilator rate (p <0.01), higher peak inspiratory pressures (p <0.001), and higher positive end-expiratory pressure (p <0.0001) than those receiving placebo. There was no difference in long-term outcome with respect to the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, or sepsis or with respect to the duration of ventilator use. Conclusions: Although there was a reduction in stress markers in the infants receiving fentanyl, we were unable to demonstrate an improvement in catabolic state or long-term outcome. In addition, the infants receiving fentanyl required higher ventilatory support in the early phase of respiratory distress syndrome than did those receiving placebo.

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