Clinical impact of analgesic-sedative agents and peri-operative clinical status on white matter brain injury in preterm infants following surgical NEC

J Neonatal Perinatal Med. 2023;16(3):527-537. doi: 10.3233/NPM-230084.

Abstract

Background: The potential influence of exposure to analgesic-sedative agents (ASA) before, during, and after surgical NEC and peri-operative clinical status on white matter injury (WMI) in preterm infants has not been fully defined, and a comprehensive evaluation may inform future research and clinical interventions.

Methods: A retrospective study comparing ASA exposure before/during /after surgical NEC and peri-operative clinical status in neonates with and without WMI.

Results: Infants with any WMI (grade 2-4, n = 36/67, 53.7%) had a higher number of surgical procedures receiving ASA (5 [IQR: 3, 8] vs. 3 [2, 4]; p = 0.002) and had a longer duration of hypotension during their first (48.0 hours [26.0, 48.0] vs. 15.5 [6, 48]; p = 0.009) and second surgery (20 hours [0, 48h] vs. 0 [0, 22]; p = 0.017), received more hydrocortisone (35% vs.13.3%,p = 0.04) than those without any WMI. There were no differences in fentanyl/morphine/midazolam exposure before/during/after the NEC onset in the two groups.Infants with severe WMI (19/67, 28.3%, grade 3/4) had a higher incidence of AKI (P = 0.004), surgical morbidity (p = 0.047), more surgical procedures (6.5 [3, 10] vs. 4 [2, 5]; p = 0.012), and received higher mean fentanyl doses(p = 0.03) from birth until NEC onset than those without severe WMI. The univariate associations between these factors and severe WMI remained insignificant after multivariable logistic regression.

Conclusion: Infants with WMI had more surgical procedures receiving ASA and had a longer duration of hypotension during surgeries. A large multicenter prospective study is needed to understand the full impact of ASA.

Keywords: Analgesics-sedatives; brain injury; neonate; outcomes; preterm infant.

Publication types

  • Multicenter Study

MeSH terms

  • Analgesics / adverse effects
  • Brain Injuries*
  • Fentanyl / adverse effects
  • Humans
  • Hypnotics and Sedatives
  • Hypotension*
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Magnetic Resonance Imaging / methods
  • Retrospective Studies
  • White Matter* / diagnostic imaging

Substances

  • Hypnotics and Sedatives
  • Analgesics
  • Fentanyl