OPIOID TOLERANCE AND DEPENDENCE IN INFANTS AND CHILDREN

Objectives: To review the definitions and scientific basis for opioid tolerance and dependence in neonates and older children; to assess obj ective methods for the clinical evaluation of opioid abstinence syndro mes in this age group; and to suggest therapeutic strategies for the t reatment of opioid abstinence in critically ill neonates and children. Data Sources: The published literature on opioid tolerance and depend ence in pediatric patients was reviewed. Data from current clinical pr actices, nursing procedures, and ongoing clinical research were evalua ted. Data Synthesis: Currently proposed mechanisms of opioid tolerance and dependence are assessed, with particular relevance to the develop ing human central nervous system. The validity and clinical role of cu rrently available objective methods for the assessment of opioid absti nence in neonates and older infants are defined. The efficacy of vario us pharmacologic and nonpharmacologic modalities for the treatment of opioid abstinence is evaluated and compared, and a therapeutic approac h based on receptor mechanisms, clinical monitoring data, and pharmaco logic efficacy is suggested. Conclusions: Important parallels for ther apeutically-induced opioid tolerance and withdrawal may be drawn from the assessment and management of neonates born from opioid-addicted mo thers. Opioid withdrawal can be prevented with appropriate weaning sch edules, diagnosed by objective clinical methods, and treated by a vari ety of pharmacologic and non-pharmacologic means. Pharmacologic therap y includes the use of opioids, with adjuvant drugs such as diazepam, c lonidine, or chlorpromazine. The pathophysiology and assessment of the rapeutically induced opioid tolerance and withdrawal merit further res earch in critically ill pediatric patients.