TO PROVIDE OPTIMAL CARE FOR selected neonates in a neonatal intensive care unit (NICU), opioid sedation and analgesia may be required. Not only is this a caring approach, but there is mounting evidence that biochemical and physiologic stress responses to acute disease may directly influence the neonate’s outcome.1Opioid analgesia and sedation decrease pulmonary vascular responsiveness and help to prevent movement that may dislodge extracorporeal membrane oxygenation cannulas.2Appropriate opioid analgesia has been associated with improved survival of neonates with congenital diaphragmatic hernia, as well as with reduced frequency of postoperative complications in preterm neonates after ligation for patent ductus arteriosus and in those infants with more complicated cardiac surgery.1