Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes
ObjectivesWe aimed to evaluate (1) whether sedation analgesia (SA) used during therapeutic hypothermia (TH) was efficient to support the wellbeing of neonates with hypoxic-ischemic encephalopathy, (2) the SA level and its adjustment to clinical pain scores, and (3) the impact of inadequate SA on sho...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1057724/full |
| _version_ | 1811157804466044928 |
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| author | Pauline Nakhleh-Philippe Pauline Nakhleh-Philippe Claire Zores Claire Zores Amélie Stern-Delfils Benoît Escande Dominique Astruc François Severac Pierre Kuhn Pierre Kuhn Pierre Kuhn |
| author_facet | Pauline Nakhleh-Philippe Pauline Nakhleh-Philippe Claire Zores Claire Zores Amélie Stern-Delfils Benoît Escande Dominique Astruc François Severac Pierre Kuhn Pierre Kuhn Pierre Kuhn |
| author_sort | Pauline Nakhleh-Philippe |
| collection | DOAJ |
| description | ObjectivesWe aimed to evaluate (1) whether sedation analgesia (SA) used during therapeutic hypothermia (TH) was efficient to support the wellbeing of neonates with hypoxic-ischemic encephalopathy, (2) the SA level and its adjustment to clinical pain scores, and (3) the impact of inadequate SA on short-term neonatal outcomes evaluated at discharge.MethodsThis was an observational retrospective study performed between 2011 and 2018 in two level III centers in Alsace, France. We analyzed the wellbeing of infants by using the COMFORT-Behavior (COMFORT-B) clinical score and SA level during TH, according to which we classified infants into four groups: those with excess SA, adequate SA, lack of SA, and variability of SA. We analyzed the variations in doses of SA and their justification. We also determined the impact of inadequate SA on neonatal outcomes at discharge by multivariate analyses with multinomial regression, with adequate SA as the reference.ResultsA total of 110 patients were included, 89 from Strasbourg university hospital and 21 from Mulhouse hospital. The COMFORT-B score was assessed 95.5% of the time. Lack of SA was mainly found on the first day of TH (15/110, 14%). In all, 62 of 110 (57%) infants were in excess of SA over the entire duration of TH. Most dose variations were related to clinical pain scores. Inadequate SA was associated with negative short-term consequences. Infants with excess of SA had a longer duration of mechanical ventilation [mean ratio 1.46, 95% confidence interval (CI), 1.13–1.89, p = 0.005] and higher incidence of abnormal neurological examination at discharge (odds ratio 2.61, 95% CI, 1.10–6.18, p = 0.029) than infants with adequate SA.DiscussionAdequate SA was not easy to achieve during TH. Close and regular monitoring of SA level may help achieve adequate SA. Excess of SA can be harmful for newborns with hypoxic-ischemic encephalopathy who are undergoing TH. |
| first_indexed | 2024-04-10T05:12:28Z |
| format | Article |
| id | doaj.art-3ca2d27fb3364971acaa20ac9f0528c9 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-10T05:12:28Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-3ca2d27fb3364971acaa20ac9f0528c92023-03-09T06:13:04ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-03-011110.3389/fped.2023.10577241057724Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomesPauline Nakhleh-Philippe0Pauline Nakhleh-Philippe1Claire Zores2Claire Zores3Amélie Stern-Delfils4Benoît Escande5Dominique Astruc6François Severac7Pierre Kuhn8Pierre Kuhn9Pierre Kuhn10Department of Neonatology, University Hospital of Strasbourg, Strasbourg, FranceDepartment of Neonatology, Hospital of Mulhouse, Mulhouse, FranceDepartment of Neonatology, University Hospital of Strasbourg, Strasbourg, FranceStrasbourg University, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, FranceDepartment of Neonatology, Hospital of Mulhouse, Mulhouse, FranceDepartment of Neonatology, University Hospital of Strasbourg, Strasbourg, FranceDepartment of Neonatology, University Hospital of Strasbourg, Strasbourg, FranceDepartment of Public Health and Epidemiology, University Hospital of Strasbourg, Strasbourg, FranceDepartment of Neonatology, University Hospital of Strasbourg, Strasbourg, FranceStrasbourg University, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, FranceNeonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, SwedenObjectivesWe aimed to evaluate (1) whether sedation analgesia (SA) used during therapeutic hypothermia (TH) was efficient to support the wellbeing of neonates with hypoxic-ischemic encephalopathy, (2) the SA level and its adjustment to clinical pain scores, and (3) the impact of inadequate SA on short-term neonatal outcomes evaluated at discharge.MethodsThis was an observational retrospective study performed between 2011 and 2018 in two level III centers in Alsace, France. We analyzed the wellbeing of infants by using the COMFORT-Behavior (COMFORT-B) clinical score and SA level during TH, according to which we classified infants into four groups: those with excess SA, adequate SA, lack of SA, and variability of SA. We analyzed the variations in doses of SA and their justification. We also determined the impact of inadequate SA on neonatal outcomes at discharge by multivariate analyses with multinomial regression, with adequate SA as the reference.ResultsA total of 110 patients were included, 89 from Strasbourg university hospital and 21 from Mulhouse hospital. The COMFORT-B score was assessed 95.5% of the time. Lack of SA was mainly found on the first day of TH (15/110, 14%). In all, 62 of 110 (57%) infants were in excess of SA over the entire duration of TH. Most dose variations were related to clinical pain scores. Inadequate SA was associated with negative short-term consequences. Infants with excess of SA had a longer duration of mechanical ventilation [mean ratio 1.46, 95% confidence interval (CI), 1.13–1.89, p = 0.005] and higher incidence of abnormal neurological examination at discharge (odds ratio 2.61, 95% CI, 1.10–6.18, p = 0.029) than infants with adequate SA.DiscussionAdequate SA was not easy to achieve during TH. Close and regular monitoring of SA level may help achieve adequate SA. Excess of SA can be harmful for newborns with hypoxic-ischemic encephalopathy who are undergoing TH.https://www.frontiersin.org/articles/10.3389/fped.2023.1057724/fullneonatetherapeutic hypothermiasedationanalgesiacomfortpain |
| spellingShingle | Pauline Nakhleh-Philippe Pauline Nakhleh-Philippe Claire Zores Claire Zores Amélie Stern-Delfils Benoît Escande Dominique Astruc François Severac Pierre Kuhn Pierre Kuhn Pierre Kuhn Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes Frontiers in Pediatrics neonate therapeutic hypothermia sedation analgesia comfort pain |
| title | Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes |
| title_full | Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes |
| title_fullStr | Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes |
| title_full_unstemmed | Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes |
| title_short | Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes |
| title_sort | adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short term neonatal outcomes |
| topic | neonate therapeutic hypothermia sedation analgesia comfort pain |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1057724/full |
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