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Assistant Professor, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM
Clinical Pharmacist, Department of Pharmacy, University Hospital, University of New Mexico Health Sciences Center
Associate Professor, Department of Pediatrics, University of New Mexico Health Sciences Center
Professor, Department of Pediatrics, University of New Mexico Health Sciences Center
Reprints: Karen D Dominguez PharmD, College of Pharmacy, University of New Mexico Health Sciences Center, 2502 Marble NE, Albuquerque, NM 87131-5691, FAX 505/272-4721, E-mail kdominguez{at}salud.unm.edu
OBJECTIVE: To determine the occurrence of and risk factors for opioid withdrawal in critically ill neonates receiving continuous infusions of fentanyl.
DESIGN: A prospective interventional cohort study was conducted in a university hospital neonatal intensive care unit with 19 neonates who received a minimum of 24 hours of fentanyl by continuous infusion.
MEASUREMENTS: Fentanyl total dose, duration of infusion,
and peak infusion rate were recorded. Patients were evaluated for withdrawal
using the Neonatal Abstinence Scoring System of Finnegan. Patients with a
score 
8 were considered to have opioid withdrawal.
MAIN RESULTS: Withdrawal was observed in 10 (53%) of 19
neonates. The fentanyl total dose (median 525 vs. 168 µg/kg, respectively;
p = 0.03) and infusion duration (median 10 vs. 7 d, respectively; p = 0.04)
were significantly greater in neonates with withdrawal compared to those
without withdrawal. A fentanyl total dose 415 µg/kg predicted
withdrawal with 70% sensitivity and 78% specificity. A fentanyl infusion
duration 8 days predicted withdrawal with 90% sensitivity and 67%
specificity. The most frequent symptoms of withdrawal were sleeping <3
hours after feeding (81%) and increased muscle tone (55%). In all neonates
with withdrawal, onset occurred within 24 hours of fentanyl
discontinuation.
CONCLUSIONS: Opioid withdrawal occurs frequently in critically ill neonates who receive continuous infusions of fentanyl. Longer infusion duration and higher total dose were associated with withdrawal symptoms.
Key Words: fentanyl, neonates, opioid withdrawal
Published Online, February 28, 2003. www.theannals.com, DOI 10.1345/aph.1C324
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