Objective: To identify factors that affect the decision of prescribing opioids for intubated and ventilated neonates.
Material and method: Retrospective study of intubated and ventilated newborn infants for periods longer than one hour, admitted to the NICU from January 1995 to June 1997. During this period, 203 patients fulfilled inclusion criteria and data of 176 charts were reviewed. Charts were analyzed regarding demographic data, characteristics of analgesia and respiratory support, invasive procedures performed and clinical entities diagnosed during the period of mechanical ventilation. Discriminative analysis was used to understand factors that lead to opioid use by some of these patients.
Results: Ninety-seven neonates received at least one dose of opioids during the period of mechanical ventilation. None of these patients was evaluated with pain scales, and in 63% of them we could not retrieve any reason for opioid prescription in their charts. Discriminative analysis showed that the main differences between groups were birthweight, gestational age, oxygenation index at intubation, and number of arterial sticks during the first 72 hours of mechanical ventilation. The most mature and heaviest neonates with a more severe respiratory insufficiency received opioid analgesia during ventilation.
Conclusion: The decision to use opioids in intubated and ventilated neonates was based on the infants' aspect and respiratory status. It did not consider the pain these patients might be suffering and it was not based on the evaluation of pain.