Pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia

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Bäcke, PyrolaUppsala University,Uppsala universitet,Perinatal, neonatal och barnkardiologisk forskning,Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden,Uppsala University Hospital (författare)

Pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia

Artikel/kapitelEngelska2022

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John Wiley & Sons,2022
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LIBRIS-ID:oai:DiVA.org:oru-102184
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-102184URI
https://doi.org/10.1002/14651858.CD015023.pub2DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-501136URI
https://lup.lub.lu.se/record/3d22160c-d92a-4cd7-bc62-d7eddcf1d926URI

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Språk:engelska
Sammanfattning på:engelska

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Funding agencies:Institute for Clinical Sciences, Lund University, Lund, SwedenVermont Oxford Network, USASkåne University Hospital
BACKGROUND: Newborn infants affected by hypoxic-ischemic encephalopathy (HIE) undergo therapeutic hypothermia. As this treatment seems to be associated with pain, and intensive and invasive care is needed, pharmacological interventions are often used. Moreover, painful procedures in the newborn period can affect pain responses later in life, impair brain development, and possibly have a long-term negative impact on neurodevelopment and quality of life.OBJECTIVES: To determine the effects of pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia. Primary outcomes were analgesia and sedation, and all-cause mortality to discharge.SEARCH METHODS: We searched CENTRAL, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the trial register ISRCTN in August 2021. We also checked the reference lists of relevant articles to identify additional studies.SELECTION CRITERIA: We included randomized controlled trials (RCT), quasi-RCTs and cluster-randomized trials comparing drugs used for the management of pain or sedation, or both, during therapeutic hypothermia: any opioids (e.g. morphine, fentanyl), alpha-2 agonists (e.g. clonidine, dexmedetomidine), N-Methyl-D-aspartate (NMDA) receptor antagonist (e.g. ketamine), other analgesics (e.g. paracetamol), and sedatives (e.g. benzodiazepines such as midazolam) versus another drug, placebo, no intervention, or non-pharmacological interventions. Primary outcomes were analgesia and sedation, and all-cause mortality to discharge.DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies identified by the search strategy for inclusion. We planned to use the GRADE approach to assess the certainty of evidence. We planned to assess the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We planned to evaluate treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. MAIN RESULTS: We did not find any completed studies for inclusion. Amongst the four excluded studies, topiramate and atropine were used in two and one trial, respectively; one study used dexmedetomidine and was initially reported in 2019 to be a randomized trial. However, it was an observational study (correction in 2021). We identified one ongoing study comparing dexmedetomidine to morphine.AUTHORS' CONCLUSIONS: We found no studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia.

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Bruschettini, MatteoLund University,Lunds universitet,Neonatologi,Forskargrupper vid Lunds universitet,Neonatology,Lund University Research Groups,Cochrane Sweden,Skåne University Hospital(Swepub:lu)med-mb14 (författare)
Sibrecht, GretaNewborns' Infectious Diseases Department, Poznan University of Medical Sciences, Poznan, Poland,Poznan Univ Med Sci, Newborns Infect Dis Dept, Poznan, Poland. (författare)
Thernström Blomqvist, Ylva,1974-Uppsala University,Uppsala universitet,Perinatal, neonatal och barnkardiologisk forskning,Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden,Uppsala University Hospital(Swepub:uu)ylvbl441 (författare)
Olsson, Emma,1980-Örebro University,Örebro universitet,Institutionen för hälsovetenskaper,Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Örebro Univ, Fac Med & Hlth, Dept Pediat, Örebro, Sweden.;Örebro Univ, Sch Hlth Sci, Fac Med & Hlth, Örebro, Sweden.(Swepub:lu)em7443ol (författare)
Uppsala universitetPerinatal, neonatal och barnkardiologisk forskning (creator_code:org_t)

Sammanhörande titlar

Ingår i:Cochrane Database of Systematic Reviews: John Wiley & Sons2022:111469-493X
Ingår i:Cochrane Database of Systematic Reviews: John Wiley & Sons2022:111465-1858

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