Early opioid infusion and neonatal outcomes in preterm neonates ≤28 weeks' gestation.

We sought to assess risk-adjusted neonatal outcomes of extremely preterm infants who received opioid infusion during early postnatal period. A retrospective analysis of preterm infants ≤28 weeks' gestational age (GA) admitted to neonatal intensive care units in the Canadian Neonatal Network was conducted comparing infants on the basis of receipt of opioid infusion during day 1 and day 3 after birth. Rates of mortality, severe neurological injury, severe retinopathy of prematurity, and chronic lung disease were compared. A total 362 infants received opioid infusion on day 1 and day 3, whereas 4419 infants did not receive opioid infusion. Baseline comparison revealed higher number of males, infants of GA <26 weeks, low Apgar score, and higher Score for Neonatal Acute Physiology scores among those who received opioid infusion. Neonates who received opioid infusion had higher risk for mortality (adjusted odds ratio [AOR] 1.57, 95% confidence interval [CI] 1.13, 2.18), severe neurological injury (AOR 1.63, 95% CI 1.30, 2.04), severe retinopathy of prematurity (AOR 1. 39, 95% CI 1.08, 1.79), and bronchopulmonary dysplasia (AOR 1.36, 95% CI 1.03, 1.79). Early exposure to opioid infusion in the first 3 days was associated with higher risk of adverse outcomes in extremely preterm infants.