Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit.

Publication ,  Journal Article
Ku, LC; Simmons, C; Smith, PB; Greenberg, RG; Fisher, K; Hornik, CD; Cotten, CM; Goldberg, RN; Bidegain, M
Published in: J Neonatal Perinatal Med
2019

BACKGROUND: The intranasal route is a minimally invasive method for rapidly delivering midazolam and fentanyl to provide short-term analgesia and sedation in infants. However, intranasal use of midazolam and fentanyl is not labeled for infants and safety data are sparse. The objective of this study is to evaluate the safety of intranasal midazolam and intranasal fentanyl in infants admitted to the Neonatal Intensive Care Unit (NICU). METHODS: We retrospectively identified all infants receiving intranasal midazolam or fentanyl in the NICU from 2009 to 2015. We recorded indication for use and vital signs and determined the proportion of infants experiencing the following adverse events: death within 24 hours, hypotension, bradycardia, worsening respiratory status, and chest wall rigidity. Vital signs 4 hours before and after each dose were compared using the Wilcoxon signed-rank test. RESULTS: We identified 17 infants (gestational ages 23- 41 weeks) receiving 25 intranasal doses. None of the infants died or developed hypotension, bradycardia, or chest wall rigidity. Intranasal delivery was most commonly used for sedation during magnetic resonance imaging studies. Other indications include analgesia or sedation for retinopathy of prematurity surgery, intubation, and peripherally inserted central catheter placement. One infant receiving intranasal midazolam experienced worsening respiratory status. Vital signs before and after dosing were not significantly different. CONCLUSIONS: Intranasal midazolam and fentanyl use in term and preterm infants appeared safe and well-tolerated in this small cohort of infants. Larger, prospective studies evaluating the safety and efficacy of intranasal midazolam and fentanyl use in infants are warranted.

Duke Scholars

Published In

J Neonatal Perinatal Med

DOI

EISSN

1878-4429

Publication Date

2019

Volume

12

Issue

2

Start / End Page

143 / 148

Location

Netherlands

Related Subject Headings

  • Thoracic Wall
  • Risk Factors
  • Retrospective Studies
  • Retinopathy of Prematurity
  • Respiratory Rate
  • Respiratory Distress Syndrome, Newborn
  • Pain, Procedural
  • Ophthalmologic Surgical Procedures
  • Mortality
  • Midazolam
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ku, L. C., Simmons, C., Smith, P. B., Greenberg, R. G., Fisher, K., Hornik, C. D., … Bidegain, M. (2019). Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit. J Neonatal Perinatal Med, 12(2), 143–148. https://doi.org/10.3233/NPM-17149
Ku, L. C., C. Simmons, P. B. Smith, R. G. Greenberg, K. Fisher, C. D. Hornik, C Michael Cotten, R. N. Goldberg, and M. Bidegain. “Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit.J Neonatal Perinatal Med 12, no. 2 (2019): 143–48. https://doi.org/10.3233/NPM-17149.
Ku LC, Simmons C, Smith PB, Greenberg RG, Fisher K, Hornik CD, et al. Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit. J Neonatal Perinatal Med. 2019;12(2):143–8.
Ku, L. C., et al. “Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit.J Neonatal Perinatal Med, vol. 12, no. 2, 2019, pp. 143–48. Pubmed, doi:10.3233/NPM-17149.
Ku LC, Simmons C, Smith PB, Greenberg RG, Fisher K, Hornik CD, Cotten CM, Goldberg RN, Bidegain M. Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit. J Neonatal Perinatal Med. 2019;12(2):143–148.

Published In

J Neonatal Perinatal Med

DOI

EISSN

1878-4429

Publication Date

2019

Volume

12

Issue

2

Start / End Page

143 / 148

Location

Netherlands

Related Subject Headings

  • Thoracic Wall
  • Risk Factors
  • Retrospective Studies
  • Retinopathy of Prematurity
  • Respiratory Rate
  • Respiratory Distress Syndrome, Newborn
  • Pain, Procedural
  • Ophthalmologic Surgical Procedures
  • Mortality
  • Midazolam