A global cross-sectional survey on neonatal analgosedation: unveiling global trends and challenges through latent class analysis.

Abstract

Purpose: This study aims to analyze global prescribing patterns for analgosedation in neonates during four critical care scenarios. The research explores existing patterns, their association with geographic and sociodemographic index (SDI), and adherence to evidence-based practices.

Methods: Data from a 2024 global survey of 924 responses to 28 questions were analyzed, focusing on four items for their high variability: premedication in intubation (Q17), sedation in preterm (Q19) and full-term newborns (Q23), and perinatal asphyxia (Q26). Latent class analysis (LCA) classified neonatal intensive care unit (NICU) prescriptions into patterns, assigning participants to the most likely class. Demographic variables, including geographic region and SDI, were compared using chi-square tests to assess associations.

Results: Three distinct prescribing patterns emerged for each scenario. In premedication during intubation, Europe and North America predominantly used Class 1, adhering to guidelines with fentanyl, atropine, and muscle relaxants. In contrast, Class 2, standard in Asia and Latin America-Caribbean, primarily utilized fentanyl and midazolam, with rare use of atropine and muscle relaxants. For analgosedation in newborns, higher-SDI NICUs favored fentanyl, while lower-SDI NICUs preferred midazolam or morphine combinations. In perinatal asphyxia cases, fentanyl was the leading choice in Class 3, especially in Europe. Dexmedetomidine use was limited, primarily appearing in Class 1 NICUs.  CONCLUSION: The study highlights substantial regional variability in neonatal analgosedation, influenced by SDI and geography. Despite established guidelines, gaps in evidence-based implementation persist. These findings underscore the need for global standardization of neonatal care protocols and further research on the long-term safety of midazolam and dexmedetomidine.  What is Known: • Previous research has demonstrated significant disparities in prescribing patterns for neonatal analgosedation across geographic areas influenced by demographic and socioeconomic factors. • Midazolam remains a commonly utilized agent in neonatal analgosedation despite evidence suggesting potential neurodevelopmental risks, particularly in premature infants. • Current guidelines regarding neonatal analgesia and sedation, including premedication for endotracheal intubation, are not consistently implemented, particularly in regions characterized by lower sociodemographic indices.

What is new: • This study employs Latent Class Analysis (LCA) to categorize global neonatal prescribing practices into three distinct patterns, elucidating regional differences and compliance with evidence-based guidelines. • Care providers working in countries with higher Sociodemographic Index (SDI) are more likely to adhere to evidence-based practices, such as intubation premedication, than regions with medium or medium-high SDI. • The use of midazolam in full-term and preterm newborns exposes a gap between evidence-based guidelines and clinical practices. This situation calls for more research on the long-term safety of midazolam and the development of standardized sedation protocols that emphasize safer alternatives to reduce associated risks in neonatal care. • Dexmedetomidine is underutilized globally despite its increasing applications, highlighting the need for more pharmacokinetic and pharmacodynamic research before its inclusion in clinical guidelines.