Sedation for neonates
Sedation for neonates
Complications can occur during birth, which can lead to asphyxia in the affected neonates and result in long-term neurological damage. For this reason, the neonates in question are cooled to 33.5°C for 72 hours as part of a temporary hypothermia programme. Hypothermia leads to a slowing of the metabolism and helps the organism to overcome the consequences of the reduced oxygen supply. The corresponding hypothermia treatment to reduce long-term neurological damage is evidence-based. However, hypothermia also causes a greatly increased stress level and additional circulatory strain in the treated neonates. They are therefore sedated and ventilated during treatment. However, excessive sedation can lead to withdrawal symptoms and in turn to long-term neurological damage. Delirium and subsequent extubation are further complications that can occur in connection with sedation in the context of temporary hypothermia. A special feature to be considered when treating neonates is the slower breakdown of the sedatives administered due to the lowered body temperature, which increases the cumulative sedation dose. In order to minimise the risk and consequences of possible withdrawal symptoms, it is therefore important to reduce the dose of sedatives to be administered as much as possible without falling below the necessary depth of anaesthesia.
The Narcotrend system is available in the paediatric and neonatal intensive care unit at Oldenburg Hospital to measure the depth of anaesthesia. The system is used to register, analyse and classify the electroencephalogram (EEG) during intensive care therapy and enables the depth of anaesthesia to be determined by means of continuous EEG monitoring.
The Narcotrend system categorises the depth of anaesthesia based on the EEG data and the Narcotrend Index (NI) calculated from it in six stages (A-F), whereby A describes the awake state and F codes anaesthesia with burst suppression. In neonates, EEG monitoring cannot be used to differentiate between the middle stages of anaesthesia depth (B-E). However, the awake state (A) and too deep anaesthesia (F) can be clearly identified.
At Oldenburg Hospital, the Narcotrend system is to be used in future to monitor neonates affected by asphyxia during temporary hypothermia and the associated sedation and to reduce the sedation dose by a predetermined percentage when the anaesthetic depth stage F is reached.
Our working group in the project "Sedation in neonates"
As part of the project "Sedation in neonates", we are investigating current therapeutic approaches for neonatal asphyxia. We are investigating and evaluating the processes and the outcome of a general reduction of the sedation dose in neonates with asphyxia during hypothermia therapy using EEG monitoring for anaesthesia depth measurement.