This strategy carries risks and other drawbacks, however, Dr. Thomas M Seman, a pediatrician in group practice in Danvers, Mass., said in an interview
“Having sucrose or glucose solutions in the office can be dangerous because of the risk of overuse and hyperglycemia as well as the cost of these items,” said Dr. Seman, who was not involved with drafting the AAP statement. His office policy primarily focuses on the parents holding their children and talking, singing, or humming to them during procedures, followed by feeding and/or acetaminophen, he said.
“The other medications used are prohibitive for a number of reasons,” said Dr. Seman, although he added that most of the procedures described in the statement are performed on premature infants in a NICU with only a few done in private practices.
For example, opioids such as fentanyl and morphine are most frequently used for persistent pain, yet the data on appropriate dosing and long-term effects in the newborn period are “woefully lacking and/or conflicting,” the statement noted. The evidence for benzodiazepines, often used for sedation in the neonatal intensive care, shows little additional analgesic benefit, but these agents can potentiate the risk of respiratory depression and hypotension associated with opioid use. Caution should particularly be exercised before using methadone, ketamine, propofol, and dexmedetomidine because so little is known about safe and effective dosing of these medications in neonates. They also carry various potential risks ranging from neurotoxicity to bradycardia, desaturations, and prolonged hypotension.
While NSAIDs are not recommended at this young age, oral or intravenous acetaminophen has sufficient preliminary safety and efficacy to be considered for postoperative pain relief, according to the statement.
The AAP did not report disclosures for committee members. Dr. Boonstra, Dr. Jones, and Dr. Seman had no relevant financial disclosures.