Advances in Analgesia, Sedation, and Delirium Management in Neonates and Infants

Neonates and young infants admitted to intensive care units (ICUs) undergo frequent painful and stressful procedures, prolonged critical illness, and complex medical interventions. At the same time, assessment and management of pain, sedation, and delirium in this population remain challenging. Unlike older children, neonates and young infants cannot self-report, requiring clinicians to rely on behavioral and physiologic indicators, while rapidly changing pharmacokinetics across gestational and postnatal age contribute to variability in medication response and dosing. Overlapping features of pain, sedation, iatrogenic withdrawal, and delirium further complicate recognition and management of each. The complexity of assessment and management of each symptom leads to risk of both under- and over-treatment of symptoms. Growing concerns regarding the developing brain’s vulnerability to each symptom and exposure to pharmacologic therapies requires a thoughtful, evidence-based, and individualized approaches to care.Despite advances in symptom assessment and pharmacology, many gaps remain. Delirium remains poorly understood and frequently overlooked in neonates and young infants. Similarly, optimal strategies for analgesia and sedation, including pharmacologic and non-pharmacologic approaches, precision dosing, prevention of tolerance and withdrawal, and the impact of early exposure on neurodevelopmental outcomes, remain incompletely defined. As survival improves among medically complex neonates, there is an increasing need to better understand and address these challenges. This is also true for neonates and infants with life-limiting or life-threatening conditions where a comfort focused approach to care is provided. In these situations, sedation and analgesia, end-of-life symptom management, and family-centered approaches require consideration of clinical, ethical, and psychosocial factors.This Research Topic aims to bring together current evidence and emerging approaches to the assessment and management of analgesia, sedation, and delirium in neonates and infants across the continuum of intensive and comfort focused care. We welcome Original Research, Reviews, Mini-Reviews, Systematic Reviews, Perspectives, Case Reports, Case Series, Opinion articles, and Study Protocols addressing, but not limited to:• Validated and emerging tools for assessment of pain, sedation, and delirium in neonates and young infants• Distinguishing pain, delirium, oversedation, agitation, tolerance, and iatrogenic withdrawal• Opioid, non-opioid, and adjuvant analgesic and sedative strategies• Precision, individualized, and EHR-guided dosing approaches• Non-pharmacologic, environmental, and parent-partnered approaches to comfort and symptom management• Prevention and management of tolerance, withdrawal, and iatrogenic dependence• Epidemiology, risk factors, and predisposing conditions associated with neonatal and infant delirium• Pharmacologic management of delirium, including safety and use of antipsychotic medications• Analgesia, sedation, and delirium in the setting of prolonged sedation, chronic critical illness, and complex medical conditions• Short- and long-term neurodevelopmental and other outcomes associated with pain, analgesic, sedative, and delirium exposure• Quality-improvement initiatives and strategies to standardize analgesia, sedation, and delirium management in the NICU• Comfort-directed analgesia and sedation for neonates and infants with life-limiting or life-threatening conditions• End-of-life symptom assessment and management in the NICU• Integration of analgesia and sedation with neonatal-perinatal palliative care and birth planning Topic editors: DonnaMaria Elisa Cortezzo, Victoria J. Kain, Roberta Esteves Vieira De Castro Source: https://www.frontiersin.org/research-topics/84966/advances-in-analgesia-sedation-and-delirium-management-in-neonates-and-infants