Brain Injury and Development in Preterm Infants Exposed to Fentanyl.
Brain Injury and Development in Preterm Infants Exposed to Fentanyl.
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DOI：
10.1177/1060028015606732
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Inder TE
中科院分区：
文献类型：
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作者：
McPherson C;Haslam M;Pineda R;Rogers C;Neil JJ;Inder TE
芬太尼常用于早产儿。对于接触芬太尼的早产儿的神经发育结果，人们所知相对较少。
为了研究一组早产儿中芬太尼累积剂量与脑损伤及脑径的关系
对103名胎龄≤30周且在相当于足月年龄时接受磁共振成像检查（平均胎龄26.9±1.8周）的婴儿的人口统计学数据、围产期过程和新生儿期过程（包括在相当于足月年龄前的芬太尼总暴露量）进行了回顾性评估。对磁共振图像进行脑损伤和局部脑径评估。在相当于足月年龄和2岁时进行发育测试。
78名婴儿（76%）使用了芬太尼（中位累积剂量为3μg/kg，四分位间距为1 - 441μg/kg）。在对协变量进行校正后，出生后第一周的芬太尼累积剂量与小脑出血的发生率相关（比值比2.1，95%置信区间1.1 - 4.1）。在对包括小脑出血存在情况在内的协变量进行校正后，相当于足月年龄前的芬太尼累积剂量与小脑横径的减小相关（r = 0.461，p = 0.002）。未检测到芬太尼累积剂量与2岁时的发育之间存在相关性。
早产儿中较高的芬太尼累积剂量与相当于足月年龄时较高的小脑损伤发生率和较小的小脑直径相关。我们的研究结果必须谨慎对待，但强调了未来需要进行前瞻性试验，以研究常用镇痛药在早产儿中的风险和益处。
Fentanyl is commonly utilized in preterm infants. Relatively little is known regarding the neurodevelopmental outcomes of preterm infants exposed to fentanyl. To investigate the association between cumulative fentanyl dose and brain injury and diameters in a cohort of preterm infants Data on demographics, perinatal course, and neonatal course, including total fentanyl exposure prior to term equivalent age, were retrospectively evaluated for 103 infants born at ≤ 30 weeks gestational age who underwent magnetic resonance imaging at term equivalent age (mean gestational age 26.9 ± 1.8 weeks). Magnetic resonance images were evaluated for brain injury and regional brain diameters. Developmental testing was conducted at term equivalent and 2 years of age. Seventy-eight infants (76%) received fentanyl (median cumulative dose 3 μg/kg, interquartile range 1 – 441 μg/kg). Cumulative fentanyl dose in the first week of life correlated with the incidence of cerebellar hemorrhage after correction for covariates (OR 2.1, 95% confidence interval 1.1 – 4.1). Cumulative fentanyl dose before term equivalent age correlated with reductions in transverse cerebellar diameter after correction for covariates including the presence of cerebellar hemorrhage (r = 0.461, p = 0.002). No correlation was detected between cumulative fentanyl dose and development at 2 years of age. Higher cumulative fentanyl dose in preterm infants correlated with a higher incidence of cerebellar injury and lower cerebellar diameter at term equivalent age. Our findings must be taken with caution, but emphasize the need for future prospective trials examining the risks and benefits of commonly utilized analgesic agents in preterm infants.