Journal article
Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation
American journal of perinatology
16 Feb 2024
PMID: 38365212
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The study aims to describe our experience with the implementation of phenobarbital as a primary sedation strategy during neonatal extracorporeal membrane oxygenation (ECMO).
Retrospective chart review in a level IV neonatal intensive care unit between 2011 and 2021 comparing neonatal ECMO patients before and after the implementation of a sedation-analgesia (SA) protocol using scheduled phenobarbital as the primary sedative. Groups were compared for neonatal and ECMO characteristics, cumulative SA doses, and in-hospital outcomes. Comparison between groups was performed using Mann-Whitney test on continuous variables and chi-square on nominal variables.
Forty-two patients were included, 23 preprotocol and 19 postprotocol. Birth, pre-ECMO, and ECMO clinical characteristics were similar between groups except for a lower birth weight in the postprotocol group (
= 0.024). After standardization of phenobarbital SA protocol, there was a statistically significant reduction in median total morphine dose (31.38-17.65 mg/kg,
= 0.006) and median total midazolam dose (36.21-6.36 mg/kg,
< 0.001). There was also a reduction in median total days on morphine by 7.5 days (
= 0.026) and midazolam by 6.6 days (
= 0.003). There were no differences in ECMO duration or in-hospital outcomes between groups.
In this cohort, short-term use of phenobarbital as primary sedation strategy during neonatal ECMO was associated with reduced opioid and midazolam burden. Such reduction, however, did not affect in-hospital outcomes.
· Prolonged sedation on ECMO puts infants at risk for iatrogenic withdrawal.. · Phenobarbital is a feasible sedation strategy for ECMO.. · Phenobarbital sedation strategy may mitigate risk by decreasing opioid and midazolam burden..
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Details
- Title
- Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation
- Creators
- Vilmaris Quinones Cardona - Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PennsylvaniaEmma Byrne - Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PennsylvaniaMichelle Mejia - St. Christopher's Hospital for ChildrenSwosti Joshi - Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PennsylvaniaOgechukwu Menkiti - Drexel University
- Publication Details
- American journal of perinatology
- Publisher
- Thieme
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:001163591500001
- Scopus ID
- 2-s2.0-85185785876
- Other Identifier
- 991021854903904721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Obstetrics & Gynecology
- Pediatrics