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Sedative, analgesic use rose among critically ill infants at end of life
The use of sedatives and analgesics among dying infants in neonatal ICUs is infrequent, according to recent study results, with an increase in doses on the last day of life.
“Sedative and analgesic administration to dying infants is limited but increased over time,” Kanecia O. Zimmerman, MD, MPH, of the department of pediatrics at the Duke University School of Medicine, and colleagues wrote. “Over the last 15 years, the proportion of infants who died and were exposed to sedatives or analgesics on the day of death increased over time.”
The researchers analyzed medical records from 348 neonatal ICUs in North America of infants who died between 1997 and 2012. This information was classified by whether infants had been exposed to certain sedatives and analgesics, including opioids, benzodiazepines,
central alpha-2 agonists, ketamine and pentobarbital. The researchers compared information on sedatives and analgesics to determine the association between the use of these drugs and patient demographic, severity of illness and final day of life.
Study results showed that of the 19,726 infants who died, 48% received some type of sedative or analgesic drugs. The administration of sedatives increased toward the end of life, with 31% having received some type of pain management drug on the final day of life, whereas 33% received them within the last 2 days of life.
The most common pain management drugs administered were opioids, which made up 27% of all sedatives or analgesics given. The researchers noted that the frequency of pain management drugs administered increased between 1997 and 2012. Opioid use increased from 6% in 1997 to 36% in 2012, whereas use of benzodiazepines increased similarly, from 6% to 20%.
Study results also showed that older infants were more likely to receive sedatives on the last day of their lives, whereas low birth weight infants were less likely to receive any sedatives in a neonatal ICU.
“Opportunities exist to optimize end-of-life care for infants,” Zimmerman and colleagues wrote. “Optimized care may be accomplished through the development of standardized protocols or formalized palliative care teams specific to the end-of-life needs in infants.” – by David Costill
Disclosure: Healio.com/Pediatrics was unable to confirm relevant financial disclosures at the time of publication.
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