PROSPECTIVE-STUDY ON THE OCCURRENCE OF WITHDRAWAL IN CRITICALLY ILL CHILDREN WHO RECEIVE FENTANYL BY CONTINUOUS-INFUSION

Objective: To determine the occurrence of narcotic withdrawal in criti cally ill children who receive continuous infusions of fentanyl. Desig n: Prospective case series. Setting: A university hospital pediatric i ntensive care unit. Patients: Twenty-three children, aged 1 wk to 22 m onths (mean 6 months), who required assisted mechanical ventilation an d who received continuous infusions of fentanyl for >24 hrs. Intervent ions: None. Measurements and Main Results: Total fentanyl dose receive d, length of infusion, and peak infusion rate were recorded. Patients were evaluated for narcotic withdrawal by the Neonatal Abstinence Scor ing System of Finnegan. Children with scores of greater than or equal to 8 were considered to have narcotic withdrawal. Withdrawal was obser ved in 13 (57%) of 23 infants. Total fentanyl dose (2.96 +/- 4.10 vs. 0.53 +/- 0.37 mg/kg, p < .005) and length of fentanyl infusion (13.1 /- 11.3 vs. 3.8 +/- 1.5 days , p < .0001) were significantly greater i n those infants with narcotic withdrawal than in those infants with no withdrawal, respectively. Peak fentanyl infusion rate (9.9 +/- 7.8 vs . 9.2 +/- 4.4 mu g/kg/hr) did not differ significantly between the two groups. A total fentanyl dose of >2.5 mg/kg or a duration of infusion of >9 days was 100% predictive of withdrawal. Conclusions: Continuous infusions of fentanyl produce a high occurrence rate of narcotic with drawal when administered to critically ill children. This effect is bo th dose- and duration-dependent.