Safety and Efficacy of a Low Dose Naloxone Infusion in NICU Patients

This is a prospective, non-randomized, single center, open label dose escalation study. We hypothesize that critically ill patients in the NICU may benefit from a low dose naloxone infusion resulting in decreased tolerance, less severe withdrawal symptoms, lower cumulative doses of opiates, and fewer total days of opiates, all while maintaining adequate or enhanced pain control and sedation. Establishing safety and efficacy data for this potentially beneficial therapy is an important first step towards using this therapy to decrease the risk of opioid tolerance and withdrawal in this population of infants.

Inclusion criteria

• Neonates > 36 0/7 weeks estimated gestational age
• Less than 30 days of life
• Requiring admission to to the Neonatal Intensive Care Unit
• Requiring continuous infusions of fentanyl or morphine analgesia
• Anticipated to require opioid infusions for at least four days
• Patients must be enrolled within 120 hours of initiating opioid infusions
• All patients will also require mechanical ventilation prior to study entry.

Exclusion criteria

• Preterm infants < 36 weeks gestation
• Neonates with major neurologic anomalies, seizures
• Opioid infusion administration for > 120 hours prior to study entry
• Patients requiring ECMO support prior to study entry
• Neonates born to mothers who are known to be opioid dependent