Prolonged Apnea and Sedation in Premature Babies with the Use of OralTramadol

Clinical studies have shown that premature infants may experience pain in spite of the immaturity of anatomical and functional pathways transmitting nociceptive stimuli [1]. Over the past decade, survival rates for pre-term neonates have increased markedly [2]. The increase in premature birth and survival is provided by O2 therapy and ventilatory management. Oxygen therapy is directly related to Retinopathy of Prematurity (ROP). Screening examination for ROP is a very brief painful procedure and requires long-term follow-up [3]. Although the management of neonatal pain from major single procedures (eg, postoperative pain) has improved significantly, pain management for multiple and repetitive diagnostic and therapeutic procedures (eg, heel lances, suctioning) have not kept pace [2]. Multiple invasive procedures in premature infants caused marked fluctuations in intracranial pressure, possibly leading to early intraventricular haemorrhage and periventricular leucomalacia. Premature infants tend to be more unstable systemically than full term infants of the similar postnatal age, and are more susceptible to apnea and bradycardia [3]. Tramadol was being used in paediatric surgery department even in newborn babies undergoing surgery under general anesthesia, we thought that it could be safe and effective for ROP examination also [4-7]. Here we would like to present 3 cases who had heavy sedation and respiratory depression with the use of tramadol 2 mg/kg (one drop/kg) in premature infants for pain relief and sedation during ROP examination.