Association between Analgosedation of Premature Infants Using Fentanyl with Neurodevelopmental Outcome at the Corrected Age of 24 Months

Aims: Because of its favorable properties with rapid onset of action and a shorter half-life, fentanyl is commonly used for sedation in preterm infants with invasive mechanical ventilation and invasive procedures. However, little is known about the neurodevelopmental outcome after administration of fentanyl in the neonatal period. The aim of this retrospective study was to investigate the possible association between fentanyl in the neonatal period and the neurological level of development at the corrected age of 24 months.

Methods: In a retrospective analysis, n = 35 were preterm infants with a gestational age ≤ 32 weeks of gestation and/or a birth weight less than 1,500 g who were born in 2011 in the perinatal Grosshadern were investigated. Exclusion criteria were severe congenital malformations or suspicion of a syndromic disease. The initial clinical course (intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, necrotizing enterocolitis, and surgery), the level and duration of medication of fentanyl, and the results of neurodevelopmental follow-up using the Bayley Scales of Infant Development, 2nd Edition at the corrected age of 24 months were compared between the two groups.

Results: A total of 34 children with a mean gestational age of 27 + 0 weeks (24 + 1 SSW to 31 + 5 weeks) and a mean birth weight of 805 g (range, 410–1,200 g) were examined at the corrected age between 23 and 26 months. Overall, 10 children with a mean gestational age of 25 + 4 SSW and a mean birth weight of 758.5 g obtained sedation with fentanyl in a period of 1 to 90 days. Regarding the neurodevelopmental follow-up, there were neither significant differences between the group with fentanyl compared with the comparison group without sedation in the motor subtest (psychomotor developmental index, 79 ± 14 vs. 86 ± 9, p = 0.10) nor in the cognitive subtest (mental developmental index, 83 ± 19 vs. 94 ± 15, p = 0.09).

Conclusion: In this small cohort of preterm infants born before 32 + 0 weeks, there was no significant association between sedation with fentanyl in the neonatal period and their neurodevelopmental outcome at the age of 24 months.

Keywords: prematurity, neurodevelopmental outcome, fentanyl.