Characterization of fentanyl exposures in children less than 10 years old

Illicitly manufactured fentanyl has become increasingly relevant to pediatric populations. However, there are limited studies examining clinical course and treatment of fentanyl exposures in children to guide management. The objective of this study was to describe clinical characteristics, management, and outcomes in fentanyl exposures in children less than 10 years old.
This was a retrospective chart review at a single children’s hospital including patients less than 10 years old with a confirmed fentanyl exposure, as defined by urine fentanyl immunoassay or confirmatory urine drug test. Further chart review was performed to obtain demographics, source of exposure, symptoms, treatment, disposition, and outcomes.
Twenty-five subjects met inclusion criteria. Median age was 14 months. The majority of patients were symptomatic with central nervous system depression (92%), respiratory depression (88%), and miosis (73%). Eight patients (31%) required cardiopulmonary resuscitation. Most encounters resulted in admission (n = 22, 85%) with six patients (23%) admitted to the floor and 16 patients (62%) admitted to the intensive care unit. Twenty-three patients (92%) required at least one dose of naloxone. Of those, 10 patients received prehospital naloxone, 14 required multiple doses, and 10 received an infusion. The median time to last dose of naloxone was 219 min (IQR: 2–429 min). Response to naloxone was evidenced by improvement in respiratory rate (100%) or mental status (100%). Five patients (19%) were discharged with naloxone.
We highlight the impact fentanyl exposures have on the young pediatric population, with the majority of patients demonstrating central nervous system and respiratory depression, several requiring cardiopulmonary resuscitation, and almost all necessitating naloxone therapy and hospital admission. Fentanyl immunoassays detected over half of patients in real time, underscoring the importance of this assay.
Young patients are at risk for severe clinical symptoms following fentanyl exposure. Early recognition of fentanyl toxicity allows for timely intervention, safety assessments, and naloxone prescription upon discharge.