Drugs used on Neonates, Policy Statement American Academy of Pediatrics
Policy Statement
Pediatrics
Volume 105, Number 2
February 2000, pp 454-461
Prevention and Management of Pain and Stress in the Neonate (RE9945)
AMERICAN ACADEMY OF PEDIATRICS
Among older infants, benzodiazepines, barbiturates, chloral hydrate, and phenothiazines have been used
for sedation and to relieve anxiety. Of
these options, data are available for the use of benzodiazepines, chloral hydrate, and barbiturates
in neonates. Of the benzodiazepines, midazolam
has been approved for use in neonates, and a randomized, controlled trial has demonstrated sedative
effects.97 However, adverse hemodynamic
effects and abnormal movements have been associated with its use in neonates.94-98 If used,
a continuous infusion or administration of individual
doses over at least 10 minutes is recommended to reduce the risk of adverse effects. Data are insufficient
to assess the efficacy and safety of
lorazepam.99-103 Diazepam is not recommended owing to its long half-life, its long-acting
metabolites, and concern about the benzyl alcohol content,
although the dose of benzyl alcohol is far less than that associated with toxic effects.104,105
Chloral hydrate has been used extensively as a sedative-hypnotic in neonates106 but it is
metabolized to trichloroethanol, which competes for glucuronidation and may exacerbate hyperbilirubinemia.107
In
addition, another metabolite (trichloroacetic acid) persists for up to 1 week after a single dose.108
Owing to a long half-life for trichloroacetic acid
and trichloroethanol in premature neonates, repeated doses may be associated with adverse effects (eg,
central nervous system depression,
arrhythmias, and renal failure).109 Thus, repeated doses should not be given. Phenobarbital
has a long half-life, and barbiturates may increase the
reaction to painful stimuli.110 Evidence of the effectiveness and safety of phenothiazines
is lacking; these drugs are not recommended.
Full report: http://www.aap.org/policy/re9945.html
