Aim: This review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants.
Methods: We reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotracheal intubation in newborn infants admitted to neonatal intensive care units. The subsequent guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation approach.
Results: Our review produced five strong standard of care recommendations. One, reduce neonatal stress and use nonpharmacological analgesia during invasive ventilation. Two, favour intermittent boluses of opioids, administered after pain scores and before invasive procedures, during short expected periods of mechanical ventilation, mainly in preterm infants affected by respiratory distress syndrome. Three, do not use morphine infusion in preterm infants under 27 gestational weeks. Four, always use algometric scores to titrate analgesic drugs doses. Five, use premedication before endotracheal intubation for a more rapid, less painful, less traumatic and safer manoeuvre. We also developed 30 conditional recommendations on therapeutic options.
Conclusion: Our review produced 35 recommendations on standard care and therapeutic options relating to the analgesia and sedation of newborn infants during ventilation and before endotracheal intubation.
Keywords: Continuous positive airway pressure; Endotracheal intubation; Guidelines; Mechanical ventilation; Neonatal pain.
©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Nasal Intermittent Positive Pressure Ventilation (NIPPV) Versus Nasal Continuous Positive Airway Pressure (NCPAP) for Preterm Neonates After ExtubationB Lemyre et al. Cochrane Database Syst Rev 2 (2), CD003212. PMID 28146296. - ReviewImplications for practice NIPPV reduces the incidence of extubation failure and the need for re-intubation within 48 hours to one week more effectively than NCPAP; howeve …
Clonidine for Sedation and Analgesia for Neonates Receiving Mechanical VentilationO Romantsik et al. Cochrane Database Syst Rev 5 (5), CD012468. PMID 28488361. - ReviewAt present, evidence is insufficient to show the efficacy and safety of clonidine for sedation and analgesia in term and preterm newborn infants receiving mechanical vent …
Laryngeal Mask Airway Versus Bag-Mask Ventilation or Endotracheal Intubation for Neonatal ResuscitationMJ Qureshi et al. Cochrane Database Syst Rev 3 (3), CD003314. PMID 29542112. - ReviewLMA can achieve effective ventilation during neonatal resuscitation in a time frame consistent with current neonatal resuscitation guidelines. Compared to BMV, LMA is mor …
Early Nasal Intermittent Positive Pressure Ventilation (NIPPV) Versus Early Nasal Continuous Positive Airway Pressure (NCPAP) for Preterm InfantsB Lemyre et al. Cochrane Database Syst Rev 12 (12), CD005384. PMID 27976361. - ReviewEarly NIPPV does appear to be superior to NCPAP alone for decreasing respiratory failure and the need for intubation and endotracheal tube ventilation among preterm infan …
Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants With Respiratory Distress SyndromeM Dursun et al. J Trop Pediatr 65 (4), 352-360. PMID 30239857.nIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.
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Premedication Practices for Tracheal Intubation in Neonates Transported by French Medical Transport Teams: A Prospective Observational StudyR Carbajal et al. BMJ Open 9 (11), e034052. PMID 31727669.SA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or sem …