Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review
Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress. This scoping review determines the breadth of research undertaken for pain and stress m...
Gespeichert in:
| Veröffentlicht in: | PloS one 2023-12, Vol.18 (12), p.e0291170-e0291170 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e0291170 |
|---|---|
| container_issue | 12 |
| container_start_page | e0291170 |
| container_title | PloS one |
| container_volume | 18 |
| creator | Joshi, Mahima Muneer, Javed Mbuagbaw, Lawrence Goswami, Ipsita |
| description | Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress.
This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes.
We searched the following online databases namely, (i) MEDLINE, (ii) Web of Science, (iii) Cochrane Library, (iv) Scopus, (v) CINAHL, and (vi) EMBASE to identify published original articles between January 2005 and December 2022. We included only English full-text articles on neonates treated with TH and reported the sedation/analgesia strategy used. We excluded articles that reported TH on transport or extracorporeal membrane oxygenation, did not report the intervention strategies for sedation/analgesia, and reported hypoxic-ischemic encephalopathy in which hypothermia was not applied.
The eligible publications (n = 97) included cohort studies (n = 72), non-randomized experimental studies (n = 2), pharmacokinetic studies (n = 4), dose escalation feasibility trial (n = 1), cross-sectional surveys (n = 5), and randomized control trials (n = 13). Neonatal Pain, Agitation, and Sedation Scale (NPASS) is the most frequently used pain assessment tool in this cohort. The most frequently used pharmacological agents are opioids (Morphine, Fentanyl), benzodiazepine (Midazolam) and Alpha2 agonists (Dexmedetomidine). The proportion of neonates receiving routine sedation-analgesia during TH is center-specific and varies from 40-100% worldwide. TH alters most drugs' metabolic rate and clearance, except for Midazolam. Dexmedetomidine has additional benefits of thermal tolerance, neuroprotection, faster recovery, and less likelihood of seizures. There is a wide inter-individual variability in serum drug levels due to the impact of temperature, end-organ dysfunction, postnatal age, and body weight on drug metabolism.
No multidimensional pain scale has been tested for reliability and construct validity in hypothermic encephalopathic neonates. There is an increasing trend towards using routine sedation/analgesia during TH worldwide. Wide variability in the type of medication used, administration (bolus versus infusion), and dose ranges used emphasizes the urgent need for |
| doi_str_mv | 10.1371/journal.pone.0291170 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_3072930190</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A775659920</galeid><doaj_id>oai_doaj_org_article_e7b0709f92844ef5b5b3a55ccfa1221f</doaj_id><sourcerecordid>A775659920</sourcerecordid><originalsourceid>FETCH-LOGICAL-c586t-970919aa7170e4713159b725b1a2b104778964117d034d4d87a8f6c13a32c80a3</originalsourceid><addsrcrecordid>eNqNkttu1DAQhiMEoqXwBggsISG42MWHJI65W1UcVqpUidOtNXEmWVdJHOyEsm-Pw6ZVF_UC-cL26JvxzO8_SZ4zumZCsndXbvI9tOvB9bimXDEm6YPklCnBVzmn4uGd80nyJIQrSjNR5Pnj5EQUNKdpwU6TbhNrNBgsEOgrErCC0bqehNHDiI3FQGxPenR9vAYy9RX6xtm-Idc71-KqdNWejDv0MOA0WkN2-8HN987Ce7Ihwbhhpj3-snj9NHlUQxvw2bKfJd8_fvh2_nl1cflpe765WJmsyMeVklQxBSDjSJhKJlimSsmzkgEvGU2lLFSexoErKtIqrQoJRZ0bJkBwU1AQZ8nLQ92hdUEvSgUtqORKUKZoJLYHonJwpQdvO_B77cDqvwHnGw0-ztOiRlnS2FCteJGmWGdlVgrIMmNqYJyzOtZ6s7zm3c8Jw6g7Gwy2LUTdpqC5it-T5lHxiL76B72_uYVqIL5v-9rF3zBzUb2RMsszpfhMre-h4qqwsya6orYxfpTw9ighMiP-HhuYQtDbr1_-n738ccy-vsPuENpxF1w7zUYKx2B6AI13IXisb4VnVM-mvlFDz6bWi6lj2otFtKnssLpNunGx-APR1O_p</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3072930190</pqid></control><display><type>article</type><title>Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review</title><source>DOAJ Directory of Open Access Journals</source><source>Public Library of Science (PLoS)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Joshi, Mahima ; Muneer, Javed ; Mbuagbaw, Lawrence ; Goswami, Ipsita</creator><contributor>Demirkiran, Hilmi</contributor><creatorcontrib>Joshi, Mahima ; Muneer, Javed ; Mbuagbaw, Lawrence ; Goswami, Ipsita ; Demirkiran, Hilmi</creatorcontrib><description>Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress.
This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes.
We searched the following online databases namely, (i) MEDLINE, (ii) Web of Science, (iii) Cochrane Library, (iv) Scopus, (v) CINAHL, and (vi) EMBASE to identify published original articles between January 2005 and December 2022. We included only English full-text articles on neonates treated with TH and reported the sedation/analgesia strategy used. We excluded articles that reported TH on transport or extracorporeal membrane oxygenation, did not report the intervention strategies for sedation/analgesia, and reported hypoxic-ischemic encephalopathy in which hypothermia was not applied.
The eligible publications (n = 97) included cohort studies (n = 72), non-randomized experimental studies (n = 2), pharmacokinetic studies (n = 4), dose escalation feasibility trial (n = 1), cross-sectional surveys (n = 5), and randomized control trials (n = 13). Neonatal Pain, Agitation, and Sedation Scale (NPASS) is the most frequently used pain assessment tool in this cohort. The most frequently used pharmacological agents are opioids (Morphine, Fentanyl), benzodiazepine (Midazolam) and Alpha2 agonists (Dexmedetomidine). The proportion of neonates receiving routine sedation-analgesia during TH is center-specific and varies from 40-100% worldwide. TH alters most drugs' metabolic rate and clearance, except for Midazolam. Dexmedetomidine has additional benefits of thermal tolerance, neuroprotection, faster recovery, and less likelihood of seizures. There is a wide inter-individual variability in serum drug levels due to the impact of temperature, end-organ dysfunction, postnatal age, and body weight on drug metabolism.
No multidimensional pain scale has been tested for reliability and construct validity in hypothermic encephalopathic neonates. There is an increasing trend towards using routine sedation/analgesia during TH worldwide. Wide variability in the type of medication used, administration (bolus versus infusion), and dose ranges used emphasizes the urgent need for standardized practice recommendations and guidelines. There is insufficient data on the long-term neurological outcomes of exposure to these medications, adjusted for underlying brain injury and severity of encephalopathy. Future studies will need to develop framework tools to enable precise control of sedation/analgesia drug exposure customized to individual patient needs.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0291170</identifier><identifier>PMID: 38060481</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Agitation ; Analgesia ; Analgesics ; Anesthesia ; Asphyxia neonatorum ; Benzodiazepines ; Body temperature ; Body weight ; Brain ; Brain damage ; Brain injury ; Care and treatment ; Clinical trials ; Consciousness ; Cooling ; Dexmedetomidine ; Diagnosis ; Drug metabolism ; Drug tolerance ; Encephalopathy ; Feasibility studies ; Fentanyl ; Head injuries ; Health aspects ; Homeostasis ; Hypothermia ; Hypoxia ; Infants (Newborn) ; Injuries ; Ischemia ; Metabolic rate ; Midazolam ; Morphine ; Narcotics ; Neonates ; Neuroprotection ; Newborn babies ; Online databases ; Opioids ; Oxygenation ; Pain ; Pain perception ; Patient outcomes ; Pharmacokinetics ; Physiological aspects ; Seizures ; Shivering ; Stress management ; Systematic review ; Temperature ; Temperature effects ; Temperature tolerance ; Thermal stress ; Thermogenesis ; Traumatic brain injury</subject><ispartof>PloS one, 2023-12, Vol.18 (12), p.e0291170-e0291170</ispartof><rights>Copyright: © 2023 Joshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Joshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Joshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c586t-970919aa7170e4713159b725b1a2b104778964117d034d4d87a8f6c13a32c80a3</cites><orcidid>0000-0003-4677-6456 ; 0000-0002-6202-8725</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0291170&type=printable$$EPDF$$P50$$Gplos$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0291170$$EHTML$$P50$$Gplos$$Hfree_for_read</linktohtml><link.rule.ids>314,777,781,861,2096,2915,23847,27905,27906,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38060481$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Demirkiran, Hilmi</contributor><creatorcontrib>Joshi, Mahima</creatorcontrib><creatorcontrib>Muneer, Javed</creatorcontrib><creatorcontrib>Mbuagbaw, Lawrence</creatorcontrib><creatorcontrib>Goswami, Ipsita</creatorcontrib><title>Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress.
This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes.
We searched the following online databases namely, (i) MEDLINE, (ii) Web of Science, (iii) Cochrane Library, (iv) Scopus, (v) CINAHL, and (vi) EMBASE to identify published original articles between January 2005 and December 2022. We included only English full-text articles on neonates treated with TH and reported the sedation/analgesia strategy used. We excluded articles that reported TH on transport or extracorporeal membrane oxygenation, did not report the intervention strategies for sedation/analgesia, and reported hypoxic-ischemic encephalopathy in which hypothermia was not applied.
The eligible publications (n = 97) included cohort studies (n = 72), non-randomized experimental studies (n = 2), pharmacokinetic studies (n = 4), dose escalation feasibility trial (n = 1), cross-sectional surveys (n = 5), and randomized control trials (n = 13). Neonatal Pain, Agitation, and Sedation Scale (NPASS) is the most frequently used pain assessment tool in this cohort. The most frequently used pharmacological agents are opioids (Morphine, Fentanyl), benzodiazepine (Midazolam) and Alpha2 agonists (Dexmedetomidine). The proportion of neonates receiving routine sedation-analgesia during TH is center-specific and varies from 40-100% worldwide. TH alters most drugs' metabolic rate and clearance, except for Midazolam. Dexmedetomidine has additional benefits of thermal tolerance, neuroprotection, faster recovery, and less likelihood of seizures. There is a wide inter-individual variability in serum drug levels due to the impact of temperature, end-organ dysfunction, postnatal age, and body weight on drug metabolism.
No multidimensional pain scale has been tested for reliability and construct validity in hypothermic encephalopathic neonates. There is an increasing trend towards using routine sedation/analgesia during TH worldwide. Wide variability in the type of medication used, administration (bolus versus infusion), and dose ranges used emphasizes the urgent need for standardized practice recommendations and guidelines. There is insufficient data on the long-term neurological outcomes of exposure to these medications, adjusted for underlying brain injury and severity of encephalopathy. Future studies will need to develop framework tools to enable precise control of sedation/analgesia drug exposure customized to individual patient needs.</description><subject>Agitation</subject><subject>Analgesia</subject><subject>Analgesics</subject><subject>Anesthesia</subject><subject>Asphyxia neonatorum</subject><subject>Benzodiazepines</subject><subject>Body temperature</subject><subject>Body weight</subject><subject>Brain</subject><subject>Brain damage</subject><subject>Brain injury</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Consciousness</subject><subject>Cooling</subject><subject>Dexmedetomidine</subject><subject>Diagnosis</subject><subject>Drug metabolism</subject><subject>Drug tolerance</subject><subject>Encephalopathy</subject><subject>Feasibility studies</subject><subject>Fentanyl</subject><subject>Head injuries</subject><subject>Health aspects</subject><subject>Homeostasis</subject><subject>Hypothermia</subject><subject>Hypoxia</subject><subject>Infants (Newborn)</subject><subject>Injuries</subject><subject>Ischemia</subject><subject>Metabolic rate</subject><subject>Midazolam</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Neonates</subject><subject>Neuroprotection</subject><subject>Newborn babies</subject><subject>Online databases</subject><subject>Opioids</subject><subject>Oxygenation</subject><subject>Pain</subject><subject>Pain perception</subject><subject>Patient outcomes</subject><subject>Pharmacokinetics</subject><subject>Physiological aspects</subject><subject>Seizures</subject><subject>Shivering</subject><subject>Stress management</subject><subject>Systematic review</subject><subject>Temperature</subject><subject>Temperature effects</subject><subject>Temperature tolerance</subject><subject>Thermal stress</subject><subject>Thermogenesis</subject><subject>Traumatic brain injury</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNkttu1DAQhiMEoqXwBggsISG42MWHJI65W1UcVqpUidOtNXEmWVdJHOyEsm-Pw6ZVF_UC-cL26JvxzO8_SZ4zumZCsndXbvI9tOvB9bimXDEm6YPklCnBVzmn4uGd80nyJIQrSjNR5Pnj5EQUNKdpwU6TbhNrNBgsEOgrErCC0bqehNHDiI3FQGxPenR9vAYy9RX6xtm-Idc71-KqdNWejDv0MOA0WkN2-8HN987Ce7Ihwbhhpj3-snj9NHlUQxvw2bKfJd8_fvh2_nl1cflpe765WJmsyMeVklQxBSDjSJhKJlimSsmzkgEvGU2lLFSexoErKtIqrQoJRZ0bJkBwU1AQZ8nLQ92hdUEvSgUtqORKUKZoJLYHonJwpQdvO_B77cDqvwHnGw0-ztOiRlnS2FCteJGmWGdlVgrIMmNqYJyzOtZ6s7zm3c8Jw6g7Gwy2LUTdpqC5it-T5lHxiL76B72_uYVqIL5v-9rF3zBzUb2RMsszpfhMre-h4qqwsya6orYxfpTw9ighMiP-HhuYQtDbr1_-n738ccy-vsPuENpxF1w7zUYKx2B6AI13IXisb4VnVM-mvlFDz6bWi6lj2otFtKnssLpNunGx-APR1O_p</recordid><startdate>20231207</startdate><enddate>20231207</enddate><creator>Joshi, Mahima</creator><creator>Muneer, Javed</creator><creator>Mbuagbaw, Lawrence</creator><creator>Goswami, Ipsita</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4677-6456</orcidid><orcidid>https://orcid.org/0000-0002-6202-8725</orcidid></search><sort><creationdate>20231207</creationdate><title>Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review</title><author>Joshi, Mahima ; Muneer, Javed ; Mbuagbaw, Lawrence ; Goswami, Ipsita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c586t-970919aa7170e4713159b725b1a2b104778964117d034d4d87a8f6c13a32c80a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Agitation</topic><topic>Analgesia</topic><topic>Analgesics</topic><topic>Anesthesia</topic><topic>Asphyxia neonatorum</topic><topic>Benzodiazepines</topic><topic>Body temperature</topic><topic>Body weight</topic><topic>Brain</topic><topic>Brain damage</topic><topic>Brain injury</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Consciousness</topic><topic>Cooling</topic><topic>Dexmedetomidine</topic><topic>Diagnosis</topic><topic>Drug metabolism</topic><topic>Drug tolerance</topic><topic>Encephalopathy</topic><topic>Feasibility studies</topic><topic>Fentanyl</topic><topic>Head injuries</topic><topic>Health aspects</topic><topic>Homeostasis</topic><topic>Hypothermia</topic><topic>Hypoxia</topic><topic>Infants (Newborn)</topic><topic>Injuries</topic><topic>Ischemia</topic><topic>Metabolic rate</topic><topic>Midazolam</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Neonates</topic><topic>Neuroprotection</topic><topic>Newborn babies</topic><topic>Online databases</topic><topic>Opioids</topic><topic>Oxygenation</topic><topic>Pain</topic><topic>Pain perception</topic><topic>Patient outcomes</topic><topic>Pharmacokinetics</topic><topic>Physiological aspects</topic><topic>Seizures</topic><topic>Shivering</topic><topic>Stress management</topic><topic>Systematic review</topic><topic>Temperature</topic><topic>Temperature effects</topic><topic>Temperature tolerance</topic><topic>Thermal stress</topic><topic>Thermogenesis</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Joshi, Mahima</creatorcontrib><creatorcontrib>Muneer, Javed</creatorcontrib><creatorcontrib>Mbuagbaw, Lawrence</creatorcontrib><creatorcontrib>Goswami, Ipsita</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joshi, Mahima</au><au>Muneer, Javed</au><au>Mbuagbaw, Lawrence</au><au>Goswami, Ipsita</au><au>Demirkiran, Hilmi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-12-07</date><risdate>2023</risdate><volume>18</volume><issue>12</issue><spage>e0291170</spage><epage>e0291170</epage><pages>e0291170-e0291170</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress.
This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes.
We searched the following online databases namely, (i) MEDLINE, (ii) Web of Science, (iii) Cochrane Library, (iv) Scopus, (v) CINAHL, and (vi) EMBASE to identify published original articles between January 2005 and December 2022. We included only English full-text articles on neonates treated with TH and reported the sedation/analgesia strategy used. We excluded articles that reported TH on transport or extracorporeal membrane oxygenation, did not report the intervention strategies for sedation/analgesia, and reported hypoxic-ischemic encephalopathy in which hypothermia was not applied.
The eligible publications (n = 97) included cohort studies (n = 72), non-randomized experimental studies (n = 2), pharmacokinetic studies (n = 4), dose escalation feasibility trial (n = 1), cross-sectional surveys (n = 5), and randomized control trials (n = 13). Neonatal Pain, Agitation, and Sedation Scale (NPASS) is the most frequently used pain assessment tool in this cohort. The most frequently used pharmacological agents are opioids (Morphine, Fentanyl), benzodiazepine (Midazolam) and Alpha2 agonists (Dexmedetomidine). The proportion of neonates receiving routine sedation-analgesia during TH is center-specific and varies from 40-100% worldwide. TH alters most drugs' metabolic rate and clearance, except for Midazolam. Dexmedetomidine has additional benefits of thermal tolerance, neuroprotection, faster recovery, and less likelihood of seizures. There is a wide inter-individual variability in serum drug levels due to the impact of temperature, end-organ dysfunction, postnatal age, and body weight on drug metabolism.
No multidimensional pain scale has been tested for reliability and construct validity in hypothermic encephalopathic neonates. There is an increasing trend towards using routine sedation/analgesia during TH worldwide. Wide variability in the type of medication used, administration (bolus versus infusion), and dose ranges used emphasizes the urgent need for standardized practice recommendations and guidelines. There is insufficient data on the long-term neurological outcomes of exposure to these medications, adjusted for underlying brain injury and severity of encephalopathy. Future studies will need to develop framework tools to enable precise control of sedation/analgesia drug exposure customized to individual patient needs.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>38060481</pmid><doi>10.1371/journal.pone.0291170</doi><tpages>e0291170</tpages><orcidid>https://orcid.org/0000-0003-4677-6456</orcidid><orcidid>https://orcid.org/0000-0002-6202-8725</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-12, Vol.18 (12), p.e0291170-e0291170 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3072930190 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Agitation Analgesia Analgesics Anesthesia Asphyxia neonatorum Benzodiazepines Body temperature Body weight Brain Brain damage Brain injury Care and treatment Clinical trials Consciousness Cooling Dexmedetomidine Diagnosis Drug metabolism Drug tolerance Encephalopathy Feasibility studies Fentanyl Head injuries Health aspects Homeostasis Hypothermia Hypoxia Infants (Newborn) Injuries Ischemia Metabolic rate Midazolam Morphine Narcotics Neonates Neuroprotection Newborn babies Online databases Opioids Oxygenation Pain Pain perception Patient outcomes Pharmacokinetics Physiological aspects Seizures Shivering Stress management Systematic review Temperature Temperature effects Temperature tolerance Thermal stress Thermogenesis Traumatic brain injury |
| title | Analgesia and sedation strategies in neonates undergoing whole-body therapeutic hypothermia: A scoping review |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T18%3A18%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Analgesia%20and%20sedation%20strategies%20in%20neonates%20undergoing%20whole-body%20therapeutic%20hypothermia:%20A%20scoping%20review&rft.jtitle=PloS%20one&rft.au=Joshi,%20Mahima&rft.date=2023-12-07&rft.volume=18&rft.issue=12&rft.spage=e0291170&rft.epage=e0291170&rft.pages=e0291170-e0291170&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0291170&rft_dat=%3Cgale_plos_%3EA775659920%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3072930190&rft_id=info:pmid/38060481&rft_galeid=A775659920&rft_doaj_id=oai_doaj_org_article_e7b0709f92844ef5b5b3a55ccfa1221f&rfr_iscdi=true |