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Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life.

Publication ,  Journal Article
Zimmerman, KO; Hornik, CP; Ku, L; Watt, K; Laughon, MM; Bidegain, M; Clark, RH; Smith, PB
Published in: J Pediatr
August 2015

OBJECTIVE: To describe the administration of sedatives and analgesics at the end of life in a large cohort of infants in North American neonatal intensive care units. STUDY DESIGN: Data on mortality and sedative and analgesic administration were from infants who died from 1997-2012 in 348 neonatal intensive care units managed by the Pediatrix Medical Group. Sedatives and analgesics of interest included opioids (fentanyl, methadone, morphine), benzodiazepines (clonazepam, diazepam, lorazepam, midazolam), central alpha-2 agonists (clonidine, dexmedetomidine), ketamine, and pentobarbital. We used multivariable logistic regression to evaluate the association between administration of these drugs on the day of death and infant demographics and illness severity. RESULTS: We identified 19 726 infants who died. Of these, 6188 (31%) received a sedative or analgesic on the day of death; opioids were most frequently administered, 5366/19 726 (27%). Administration of opioids and benzodiazepines increased during the study period, from 16/283 (6%) for both in 1997 to 523/1465 (36%) and 295/1465 (20%) in 2012, respectively. Increasing gestational age, increasing postnatal age, invasive procedure within 2 days of death, more recent year of death, mechanical ventilation, inotropic support, and antibiotics on the day of death were associated with exposure to sedatives or analgesics. CONCLUSIONS: Administration of sedatives and analgesics increased over time. Infants of older gestational age and those more critically ill were more likely to receive these drugs on the day of death. These findings suggest that drug administration may be driven by severity of illness.

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Published In

J Pediatr

DOI

EISSN

1097-6833

Publication Date

August 2015

Volume

167

Issue

2

Start / End Page

299 / 304.e3

Location

United States

Related Subject Headings

  • Terminal Care
  • Pediatrics
  • North America
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Newborn
  • Infant
  • Hypnotics and Sedatives
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Zimmerman, K. O., Hornik, C. P., Ku, L., Watt, K., Laughon, M. M., Bidegain, M., … Smith, P. B. (2015). Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life. J Pediatr, 167(2), 299-304.e3. https://doi.org/10.1016/j.jpeds.2015.04.059
Zimmerman, Kanecia O., Christoph P. Hornik, Lawrence Ku, Kevin Watt, Matthew M. Laughon, Margarita Bidegain, Reese H. Clark, and P Brian Smith. “Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life.J Pediatr 167, no. 2 (August 2015): 299-304.e3. https://doi.org/10.1016/j.jpeds.2015.04.059.
Zimmerman KO, Hornik CP, Ku L, Watt K, Laughon MM, Bidegain M, et al. Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life. J Pediatr. 2015 Aug;167(2):299-304.e3.
Zimmerman, Kanecia O., et al. “Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life.J Pediatr, vol. 167, no. 2, Aug. 2015, pp. 299-304.e3. Pubmed, doi:10.1016/j.jpeds.2015.04.059.
Zimmerman KO, Hornik CP, Ku L, Watt K, Laughon MM, Bidegain M, Clark RH, Smith PB. Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life. J Pediatr. 2015 Aug;167(2):299-304.e3.
Journal cover image

Published In

J Pediatr

DOI

EISSN

1097-6833

Publication Date

August 2015

Volume

167

Issue

2

Start / End Page

299 / 304.e3

Location

United States

Related Subject Headings

  • Terminal Care
  • Pediatrics
  • North America
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Newborn
  • Infant
  • Hypnotics and Sedatives
  • Humans
  • Female