Cochrane · systematic review · CD015056
Opioids for procedural pain in neonates
Kinoshita, M, Olsson, E, Borys, F, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
26
current version
GRADE rated
17
No studies
9
Included studies
NR
No studies 9 · 34.6%Ungraded 0 · 0%Very low 13 · 50%Low 3 · 11.5%Moderate 1 · 3.8%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyOpioids compared to no treatment/placebo for procedural pain in neonates
Population: neonates exposed to procedural pain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain, assessed using the PIPP/PIPP‐R pain scale, ranging from 0 to 21 and 0 to 18 in preterm infants < 28 weeks' gestational age and full‐term infants, respectively, during procedure Opioids vs no treatment/placebo | no estimate extracted | 3 studies · 199 participants | Moderate Downgraded: imprecision, inconsistency |
Pain, assessed using the PIPP/PIPP‐R pain scale up to 30 min after procedure Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 123 participants | Very low Downgraded: imprecision, inconsistency |
Pain, assessed using the PIPP/PIPP‐R pain scale 1 to 2 hours after procedure Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 54 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the DAN pain scale, ranging from 0 to 21, 1 to 2 hours after procedure Opioids vs no treatment/placebo | no estimate extracted | 1 study · 42 participants | Low Downgraded: imprecision |
Pain, assessed using the NIPS, ranging from 0 to 7, during procedure Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 102 participants | Low Downgraded: imprecision, inconsistency |
Any harms ‐ severe apnea requiring resuscitation Opioids vs no treatment/placebo | RR 7.44 [0.42, 132.95] | 1 study · 31 participants | Very low Downgraded: imprecision |
Episodes of bradycardia Opioids vs no treatment/placebo | RR 3.19 [0.14, 72.69] | 3 studies · 172 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Episodes of apnea Opioids vs no treatment/placebo | RR 3.15 [1.08, 9.16] | 3 studies · 199 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Hypotension Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 88 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Parent satisfaction with care provided in the NICU (as measured by a validated instrument/tool)—not reported Opioids vs no treatment/placebo | no estimate extracted | NR | No studies |
Opioids compared to oral sweet solution or non‐pharmacological intervention for procedural pain in neonates
Population: neonates exposed to procedural pain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain, assessed using the CRIES pain scale, ranging from 0 to 10, during the procedure— opioids versus facilitated tucking Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the CRIES pain scale, ranging from 0 to 10, during the procedure— opioids versus sensorial stimulation Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Any harms Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Episodes of bradycardia—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Episodes of apnea—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Hypotension—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Parent satisfaction with care provided in the NICU—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Opioids compared to other analgesics for procedural pain in neonates
Population: procedural pain in neonates
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain, assessed using the PIPP/PIPP‐R pain scale, ranging from 0 to 21 and 0 to 18 in preterm infants < 28 weeks gestational age and full‐term infants, respectively, during procedure Opioids vs other analgesics | no estimate extracted | 2 studies · 124 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the PIPP/PIPP‐R pain scale up to 30 min after procedure Opioids vs other analgesics | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the PIPP/PIPP‐R pain scale 1 to 2 hours after procedure Opioids vs other analgesics | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision |
Any harms Opioids vs other analgesics | no estimate extracted | NR | No studies |
Episodes of apnea—during the procedure Opioids vs other analgesics | RR 3.27 [0.85, 12.58] | 2 studies · 124 participants | Very low Downgraded: risk of bias, imprecision |
Episodes of apnea—after the procedure Opioids vs other analgesics | RR 2.71 [0.11, 64.96] | 2 studies · 124 participants | Very low Downgraded: risk of bias, imprecision |
Episodes of bradycardia—not reported Opioids vs other analgesics | no estimate extracted | NR | No studies |
Hypotension Opioids vs other analgesics | RR 1.34 [0.32, 5.59] | 3 studies · 204 participants | Very low Downgraded: risk of bias, imprecision |
Parent satisfaction with care provided in the NICU—not reported Opioids vs other analgesics | no estimate extracted | NR | No studies |
Opioids compared to no treatment/placebo for procedural pain in neonates
Population: neonates exposed to procedural pain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain, assessed using the PIPP/PIPP‐R pain scale, ranging from 0 to 21 and 0 to 18 in preterm infants < 28 weeks' gestational age and full‐term infants, respectively, during procedure Opioids vs no treatment/placebo | no estimate extracted | 3 studies · 199 participants | Moderate Downgraded: imprecision, inconsistency |
Pain, assessed using the PIPP/PIPP‐R pain scale up to 30 min after procedure Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 123 participants | Very low Downgraded: imprecision, inconsistency |
Pain, assessed using the PIPP/PIPP‐R pain scale 1 to 2 hours after procedure Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 54 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the DAN pain scale, ranging from 0 to 21, 1 to 2 hours after procedure Opioids vs no treatment/placebo | no estimate extracted | 1 study · 42 participants | Low Downgraded: imprecision |
Pain, assessed using the NIPS, ranging from 0 to 7, during procedure Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 102 participants | Low Downgraded: imprecision, inconsistency |
Any harms Opioids vs no treatment/placebo | no estimate extracted | NR | No studies |
Episodes of bradycardia Opioids vs no treatment/placebo | RR 3.19 [0.14, 72.69] | 3 studies · 172 participants | Very low Downgraded: risk of bias, imprecision |
Episodes of apnea Opioids vs no treatment/placebo | RR 3.15 [1.08, 9.16] | 3 studies · 199 participants | Low Downgraded: risk of bias, imprecision |
Hypotension Opioids vs no treatment/placebo | no estimate extracted | 2 studies · 88 participants | Very low Downgraded: risk of bias, imprecision |
Parent satisfaction with care provided in the NICU (as measured by a validated instrument/tool)—not reported Opioids vs no treatment/placebo | no estimate extracted | NR | No studies |
Opioids compared to oral sweet solution or non‐pharmacological intervention for procedural pain in neonates
Population: neonates exposed to procedural pain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain, assessed using the CRIES pain scale, ranging from 0 to 10, during the procedure— opioids versus facilitated tucking Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the CRIES pain scale, ranging from 0 to 10, during the procedure— opioids versus sensorial stimulation Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Any harms Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Episodes of bradycardia—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Episodes of apnea—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Hypotension—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Parent satisfaction with care provided in the NICU—not reported Opioids vs oral sweet solution or non‐pharmacological intervention | no estimate extracted | NR | No studies |
Opioids compared to other analgesics for procedural pain in neonates
Population: procedural pain in neonates
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain, assessed using the PIPP/PIPP‐R pain scale, ranging from 0 to 21 and 0 to 18 in preterm infants < 28 weeks gestational age and full‐term infants, respectively, during procedure Opioids vs other analgesics | no estimate extracted | 2 studies · 124 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the PIPP/PIPP‐R pain scale up to 30 min after procedure Opioids vs other analgesics | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision |
Pain, assessed using the PIPP/PIPP‐R pain scale 1 to 2 hours after procedure Opioids vs other analgesics | no estimate extracted | 1 study · 12 participants | Very low Downgraded: risk of bias, imprecision |
Any harms Opioids vs other analgesics | no estimate extracted | NR | No studies |
Episodes of apnea—during the procedure Opioids vs other analgesics | RR 3.27 [0.85, 12.58] | 2 studies · 124 participants | Very low Downgraded: risk of bias, imprecision |
Episodes of apnea—after the procedure Opioids vs other analgesics | RR 2.71 [0.11, 64.96] | 2 studies · 124 participants | Very low Downgraded: risk of bias, imprecision |
Episodes of bradycardia—not reported Opioids vs other analgesics | no estimate extracted | NR | No studies |
Hypotension Opioids vs other analgesics | RR 1.34 [0.32, 5.59] | 3 studies · 204 participants | Very low Downgraded: risk of bias, imprecision |
Parent satisfaction with care provided in the NICU—not reported Opioids vs other analgesics | no estimate extracted | NR | No studies |