ROUTINE USE OF FENTANYL INFUSIONS FOR PAIN AND STRESS REDUCTION IN INFANTS WITH RESPIRATORY-DISTRESS SYNDROME

Objective: To determine whether fentanyl infusions given to premature infants with respiratory distress syndrome reduce stress and improve l ong- and short-term outcome, Methods: Twenty premature infants undergo ing mechanical ventilation for respiratory distress syndrome were rand omly assigned, in a double-blind fashion, to receive fentanyl by conti nuous infusion or a volume-matched placebo infusion, A behavioral stat e score was used to assess the infants' behavior, Cortisol and 11-deox ycortisol levels were measured as physiologic markers of stress, Urina ry 3-methyl histidine/creatinine molar ratio was determined and the fr actional excretion of urea was measured to assess catabolic state, Ven tilatory indexes were recorded for each infant, Results: Infants recei ving fentanyl showed significantly lower behavioral state scores (p < 0.04) and lower heart rates (p < 0.001) than those receiving placebo, 11-Deoxycortisol levels were lower in the fentanyl group on days 3, 4, and 5 of the study (p < 0.003). 3-Methyl histidine/creatinine ratios and fractional excretion of urea were not significantly different betw een the two groups, On the third day of the study, infants receiving f entanyl required a higher ventilator rate (p < 0.01), higher peak insp iratory pressures (p < 0.001), and higher positive end-expiratory pres sure (p < 0.0001) than those receiving placebo, There was no differenc e in long-term outcome with respect to the incidence of bronchopulmona ry dysplasia, intraventricular hemorrhage, or sepsis or with respect t o the duration of ventilator use, Conclusions: Although there was a re duction in stress markers in the infants receiving fentanyl, we were u nable to demonstrate an improvement in catabolic state or long-term ou tcome, In addition, the infants receiving fentanyl required higher ven tilatory support in the early phase of respiratory distress syndrome t han did those receiving placebo.