Use of narcotics and sedatives among very preterm infants in neonatal intensive care units in China: an observational cohort study

Yan Mo; Xinyue Gu; Dong Li; Wei Dai; Jing Xu; Shoo K Lee; Wenhao Zhou; Yun Cao; Qiufen Wei; Siyuan Jiang; Chinese Neonatal Network*

doi:10.21037/tp-22-672

Use of narcotics and sedatives among very preterm infants in neonatal intensive care units in China: an observational cohort study

Transl Pediatr. 2023 Jun 30;12(6):1170-1180. doi: 10.21037/tp-22-672. Epub 2023 Jun 2.

Authors

Yan Mo^#^{1

2}, Xinyue Gu^#³, Dong Li⁴, Wei Dai^{1

2}, Jing Xu⁴, Shoo K Lee^{5

6}, Wenhao Zhou^{3

7}, Yun Cao^{3

7}, Qiufen Wei^{1

2}, Siyuan Jiang^{3

7}; Chinese Neonatal Network*

Affiliations

¹ Neonatal Medical Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
² Guangxi Clinical Research Center for Pediatric Diseases, Nanning, China.
³ NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China.
⁴ Dalian Women and Children Medical Center, Dalian, China.
⁵ Maternal-Infants Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
⁷ Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Narcotics and sedatives are widely used in neonatal intensive care units for very preterm infants. This study aimed to describe the current use of narcotics and/or sedatives among very preterm infants in Chinese neonatal intensive care units, with an emphasis on infants on invasive mechanical ventilation, and to investigate the association of exposure to narcotics and/or sedatives with neonatal outcomes.

Methods: This was a retrospective observational cohort study that enrolled all infants born at 24⁺⁰-31⁺⁶ weeks and admitted to 57 tertiary neonatal intensive care units in the Chinese Neonatal Network in 2019. A multivariate logistic regression model was used to assess the association between narcotics and/or sedatives exposure and major neonatal outcomes.

Results: Among 9,442 very preterm infants enrolled, 1,566 (16.6%) received at least one dose of narcotics or sedatives, 111 (1.2%) received only narcotics, 1,301 (13.8%) received sedatives solely, and 154 (1.6%) received both narcotics and sedatives during their hospital stay. Of 4,172 very preterm infants who underwent invasive mechanical ventilation, 1,117 (26.8%) received at least one dose of narcotics or sedatives, with 883 (21.2%) only received sedatives. Significant site variation of narcotics/sedatives use existed among hospitals, with the application rate ranging from 0-72.5% in individual hospital. The narcotics and/or sedatives use by very preterm infants was independently associated with increased risks for periventricular leukomalacia, severe retinopathy of prematurity, and bronchopulmonary dysplasia.

Conclusions: Narcotic and/or sedative administration is relatively conservative for very preterm infants in Chinese neonatal intensive care units, with significant variation among hospitals. Since narcotic and sedative use might be related to adverse neonatal outcomes, a pressing and developing need for national quality improvement initiatives is seen with respect to pain/stress management for very preterm infants.

Keywords: Cohort studies; invasive mechanical ventilation; narcotic; premature infant; sedative.