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Sedation in the Neonatal Intensive Care Unit: International Practice

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Pediatric Sedation Outside of the Operating Room

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Abstract

Inadequate pain management in neonatal life impairs neurodevelopmental outcome because it alters pain thresholds, pain- or stress-related behavior, and physiological responses later in life. However, there are recently also emerging animal experimental and human epidemiological data on the impact of analgo-sedatives on neuro-apoptosis and impaired neurodevelopmental outcome. As a consequence, the management of neonatal pain is in search of a new balance, and these conflicting observations are the main drivers to tailor our pain management in neonates. Adequate pain management is based on prevention, assessment, and treatment with subsequent reassessment. Issues related to prevention and assessment tools are covered. Non-pharmacological (e.g., complementary interventions like facilitated tucking, nonnutritive sucking) and pharmacological (e.g., acetaminophen, opioids, ketamine, propofol) treatment modalities were reviewed and reflect the increased knowledge on neonatal pain management. Each topic ends with some take-home messages that in part also reflect our opinion on the current status of this topic.

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Authors and Affiliations

  1. Department of Growth and Regeneration, KU Leuven and Neonatal Intensive Care Unit, University Hospitals Leuven, NICU, Herestraat 49, Leuven, 3000, Belgium

    Karel Allegaert M.D., Ph.D.

  2. Department of Pediatrics, Pharmacology and Physiology, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA

    John van den Anker M.D., Ph.D.

  3. Intensive Care, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands

    John van den Anker M.D., Ph.D.

  4. Department of Pediatric Pharmacology, University Children’s Hospital Basel, Basel, Switzerland

    John van den Anker M.D., Ph.D.

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  1. Karel Allegaert M.D., Ph.D.
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  2. John van den Anker M.D., Ph.D.
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Correspondence to Karel Allegaert M.D., Ph.D. .

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  1. Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, USA

    Keira P. Mason

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Allegaert, K., van den Anker, J. (2015). Sedation in the Neonatal Intensive Care Unit: International Practice. In: Mason, K. (eds) Pediatric Sedation Outside of the Operating Room. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1390-9_15

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