Short-Term Effects of Opioid Use During Therapeutic Hypothermia for Neonatal Encephalopathy

Abstract Objective To examine the effects of opioids during therapeutic hypothermia (TH) on short-term clinical outcomes in neonates with neonatal encephalopathy (NE). Methods Multicenter retrospective study of neonates with moderate/severe NE. Opioid exposure was classified as positive (> 0.1 mg/kg) or negative (no exposure or ≤ 0.1 mg/kg) based on cumulative morphine milligram equivalents (MME). Negative binomial regression models were used to evaluate clinical outcomes. Results One hundred and twenty neonates were included. Positive opioid exposure was associated with an increase in: 1) length of hospitalization, 2) hypotension/use of vasopressors, and 3) need for and longer duration of mechanical ventilation. Findings were seen with morphine and fentanyl (continuous infusion or intermittent bolus) and were worse with concurrent administration of antiepileptics. Conclusions Opioid use during TH was associated with adverse effects on short term clinical outcomes. Caution should be exercised when using opioids during TH until longer-term neurodevelopmental outcome studies can be examined in larger cohorts.