If the baby is so agitated on nCPAP but he still needs it ,

is it permissible to use any kind of sedation with him ?

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Mohamad Ismail ,

Neonatology resident ,

Mansoura , Egypt .

Usually larger babies are difficult to manage on CPAP with out sedation and smaller ones tolerate quite well with out sedation.We also debate multiple times on the nature of sedation to be given and some times we trick the babies with a oral pacifier and rarely we use Oral Pedichloryl

we cant sedation,beacuse this is increase pco2 and we cant wean cpap,oral pacifier is good idea beacuse increase efficacy cpap and relaxtion baby

We sometimes use low dose morphine infusion on our bigger babies. We use other means first like pacifiers, sucrose, kangaroo'ing but in the end, sedation is a possibility.If we have an increase of PCO2 within the next 24 to 48 hrs post sedation use, most likely we stop the sedation.

Some degree of "cooperation" is needed for effective CPAP therapy.

If alternatives like pacifier etc, I would also use low dose analgetics or sedatives.

One important aspect is to consider why the baby is agitated and relieve symtoms by cause.

Dear friends ,

I do agree with Stefan.for effective CPAP cooperation of baby is must.we use pacifier routinely in large baby ,some time a single dose of sedative will help .we use phenobarbitone 5 mg/kg once only.before that we ruled out hypoxemia and hypercarbia as well as over/under distention of lung by x-ray chest ,optimum CPAP help in reducing agitaton of infant.

Dinesh

I agree. We don't use sedation. Find out why baby is agitated. Pacifier, sucrose/ breast milk, swaddling, KMC, correct fitting prongs and hat etc all work well. Developmental care principles esp. positioining must encouraged.

We use sucrose but if still unmanageablewe use low dose chloral hydrate..

ruleout hypoxia and hypercarbia and if simple measures fail

we give low dose sedation .

Hi,

I agree with Ruth.

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HFNC SOME TIME HELP

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Actually in my experience use of mild sedation in CPAP patient unavoidable but cautious use of short half life and low dose narcotics like fentanil  or midazolam is advised.

 

dr Ghodstehrani  senior specialist neonatologist

Iranian hospital Dubai

We don't use sedation either - well fitting prongs and hat, positioning, swaddling, pacifier, occasionally a little dextrose gel. Meticulous nursing care and attention is essential.