Am J Perinatol
DOI: 10.1055/s-0044-1779255
Original Article

Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation

1   Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
2   Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
2   Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
Michelle Mejia
1   Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
Swosti Joshi
1   Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
2   Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
Ogechukwu Menkiti
1   Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
2   Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
› Author Affiliations
Funding None.


Objective The study aims to describe our experience with the implementation of phenobarbital as a primary sedation strategy during neonatal extracorporeal membrane oxygenation (ECMO).

Study Design Retrospective chart review in a level IV neonatal intensive care unit between 2011 and 2021 comparing neonatal ECMO patients before and after the implementation of a sedation-analgesia (SA) protocol using scheduled phenobarbital as the primary sedative. Groups were compared for neonatal and ECMO characteristics, cumulative SA doses, and in-hospital outcomes. Comparison between groups was performed using Mann–Whitney test on continuous variables and chi-square on nominal variables.

Results Forty-two patients were included, 23 preprotocol and 19 postprotocol. Birth, pre-ECMO, and ECMO clinical characteristics were similar between groups except for a lower birth weight in the postprotocol group (p = 0.024). After standardization of phenobarbital SA protocol, there was a statistically significant reduction in median total morphine dose (31.38–17.65 mg/kg, p = 0.006) and median total midazolam dose (36.21–6.36 mg/kg, p < 0.001). There was also a reduction in median total days on morphine by 7.5 days (p = 0.026) and midazolam by 6.6 days (p = 0.003). There were no differences in ECMO duration or in-hospital outcomes between groups.

Conclusion In this cohort, short-term use of phenobarbital as primary sedation strategy during neonatal ECMO was associated with reduced opioid and midazolam burden. Such reduction, however, did not affect in-hospital outcomes.

Key Points

  • Prolonged sedation on ECMO puts infants at risk for iatrogenic withdrawal.

  • Phenobarbital is a feasible sedation strategy for ECMO.

  • Phenobarbital sedation strategy may mitigate risk by decreasing opioid and midazolam burden.

Availability of Data and Materials

The data were extracted from patient charts and database can be provided upon request.

Authors' Contribution

Construction of the project was created by V.Q.C., S.J., and O.M. Data collection was conducted by E.B. and M.M. Statistical analysis was done by V.Q.C. and S.J. First draft of manuscript was written by E.B. and V.Q.C. All authors edited and approved manuscript.

Supplementary Material

Publication History

Received: 06 August 2023

Accepted: 01 January 2024

Article published online:
16 February 2024

© 2024. Thieme. All rights reserved.

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