Infant populations at risk for possible short-term and long-term consequences after exposure to prolonged sedation
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INTRODUCTION: Prolonged sedation treatment in neonatal pediatric populations is associated with opioid and benzodiazepine tolerance, dependence, and withdrawal syndrome. Despite the clinical relevance of this problem, we have limited knowledge of the long-term repercussions. Current literature focuses on premature neonates and suggests that opioid exposure may cause neurodevelopmental sequelae. The main objective of this literature review was to investigate what infant populations are at risk of developing short-term and/or long-term consequences from prolonged infantile sedation exposure. PUBLISHED STUDIES: A literature review was conducted on previous studies that focused primarily on the effects of opioids and benzodiazepines on infants and how it may affect the future development in these children. Studies show that short-term consequences include increased heart rate, increased respiratory rate, increased blood pressure, intracranial pressure fluctuations, and risk of further complications such as intraventriculat hemorrhage (IVH), periventricular leukomalacia (PVL), or even death. Long-term repercussions incluse the possibility of decreased brain volume, decreased head circumference and body weight, intelligence deficits, and social and behavioral issues. DISCUSSION: Standard pain and sedation management involves the use of opioids and benzodiazepines. Treatment duration and medication dosage depend on severity of the patient’s illness. Since prolonged sedation administration is often associated with tolerance and dependence, future research (such as long-term follow up of these infants at later neurological milestones) is necessary to determine possible short-term and long-term neurological and behavioural sequelae for infants exposed to prolonged treatment with opioids and benzodiazepines. Standardized pain and sedation management guidelines may also increase the effectiveness of treatment and drug administration.