CLINICAL ISSUES
Sleeping Beauties: The Impact of Sedation on Neonatal Development

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Sedatives are frequently administered in neonatal intensive care to induce sleep for diagnostic and radiology procedures, calm irritable infants, manage pain-related agitation, and enhance ventilation. The pharmacology and side effects of sedatives commonly used with neonates will be reviewed and placed within the context of their potential effect on neonatal development. Alternative caregiving strategies to minimize or eliminate the need for sedation will be discussed.

Section snippets

Irritability in Infants

Irritability may be cited as a reason for sedation. Many variables (see Figure 1), often interrelated, contribute to the development of chronic irritability in infants in an NICU. The management of irritable infants requires a thorough investigation of potential associated factors in order to create an appropriate plan.

Some infants who have progressed from acute illness to chronic stages of recovery may already be in a negative response cycle of irritability. Behaviors may include hyperarousal

Sedation to Enhance Ventilation

Asynchronous breathing has often been an indication for the use of sedatives in the NICU. Infants who “fight” the ventilator are at an increased risk for complications such as pneumothorax and intraventricular hemorrhage. Sedatives are used for prolonged periods of time to depress respiratory effort and facilitate more optimal ventilation patterns (Anand et al., 1999). Short-term neurological complications have been reported in ventilated preterm neonates treated with midazolam (Anand et al.,

Conclusions and Implications for Practice

Sedative agents are important adjuncts to clinical care in situations where immobilization is required to complete a medically necessary diagnostic test or procedure. Unfortunately, an ideal sedative that has a good record of safety and efficacy is not available. In light of more recent research on the developing brain’s vulnerabilities to neurotoxic agents, caregivers must assume responsibility for the judicious and safe administration of sedative agents and for implementing alternative

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