Variation Among Neonatal Intensive Care Units in Narcotic Administration

Kahn, Doron J.; Richardson, Douglas K.; Gray, James E.; Bednarek, Francis J.; Rubin, Lewis P.; Shah, Bhavesh; Frantz, Ivan D.; Pursley, DeWayne M.

doi:10.1001/archpedi.152.9.844

Cited by 61 publications

(31 citation statements)

References 29 publications

(50 reference statements)

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“…Note that unit B used analgesics most (43% of the patientdays) and that, at the other units, the level varied from 17 to 27% of neonate-days received pharmacologic pain relief. Kahn et al 12 also evaluated pain management in 1,422 premature infants at six North-American units in 1998 with marked differences among these units. Divergences could be linked to factors related to the characteristics of the neonates themselves or of the healthcare professionals working there.…”

Section: Discussionmentioning

confidence: 99%

Freqüência do emprego de analgésicos em unidades de terapia intensiva neonatal universitárias

Prestes¹,

Guinsburg²,

Balda³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To evaluate the use of drugs to relieve the pain of invasive procedures newborn infants cared for at a university hospital NICU.Methods: A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of the hospitalized newborn infants; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Factors associated with the use of analgesia in this cohort of patients were studied by multiple linear regression using SPSS 8.0.Results: Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received systemic analgesia. No specific drugs were administered to relieve acute pain during any of the following painful events: arterial punctures, venous, capillary and lumbar punctures or intubations. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters 8% of the newborn infants received painkillers. Only nine of the 17 newborn infants that underwent surgical procedures received any analgesic dosage during the postoperative period. For 93% of patients under analgesia the drug of choice was fentanyl. The presence of mechanical ventilation increased the chance of newborn infants receiving painkillers by 6.9 times and the presence of chest tube increased this chance by five times. Conclusion:It is necessary to train health professionals in order to bridge the gap between scientific knowledge regarding newborn infant pain and clinical practice.

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Section: Discussionmentioning

confidence: 99%

Freqüência do emprego de analgésicos em unidades de terapia intensiva neonatal universitárias

Prestes¹,

Guinsburg²,

Balda³

et al. 2005

J. Pediatr. (Rio J.)

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“…31 Some studies suggest that babies require higher plasma concentrations than older children or adults to receive pain relief, 32 although other studies disagree. [33][34][35][36] In the past, morphine was thought to be a pure opioid agonist, but this theory was disproven long ago.…”

Section: Morphinementioning

confidence: 99%

Pharmacological approaches to the management of pain in the neonatal intensive care unit

Anand

2007

J Perinatol

103

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Effective and consistent management of neonatal pain remains a controversial issue.Premature infants are repeatedly subjected to painful tests and procedures or suffer painful conditions when they are most vulnerable. With different mechanisms transducing various types of pain the practice of 'one-drug fits all' becomes questionable.Clinicians must use the latest non-pharmacologic and pharmacologic therapies for effective management of neonatal pain, distress, or agitation. Pharmacologic strategies for dealing with neonatal pain in the neonatal intensive care unit are described. Opioid therapy, once considered the mainstay for neonatal analgesia, may not be as effective as previously thought. Morphine infusions do not alter the neurological outcomes of preterm neonates and may not be effective against acute pain. Alternative approaches with methadone, ketamine, or local anesthetics should be considered. Clinicians must understand the contextual circumstances underlying pain in individual neonates and tailor therapy accordingly, using the most current evidence related to neonatal pain assessment and management.

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“…This type of inter-NICU variability in disease prevalence and therapeutic intervention has been seen in our previous studies of perinatal risk and severity of illness, 8 administration of blood transfusions, 9 narcotic administration 10 and vasopressor use. 11 Site-specific differences in thrombocytopenia may be real, reflecting variability in the obstetric population, delivery method, duration of labor, incidence of Alternatively, the inter-NICU differences in thrombocytopenia may be a measurement artifact because of the variability in platelet enumeration (how the blood is drawn, the amount of time from blood drawn to platelet counting or the method of platelet counting).…”

Section: Commentsmentioning

confidence: 54%

“…We have addressed the issue of inter-NICU variability in disease prevalence and management in previous studies among a multicenter cohort of VLBW infants in the NICU [8][9][10][11] and have reported on the overall prevalence of thrombocytopenia. 6 In this current study, we made use of the existing multicenter study of this same cohort of infants to investigate the variation in rates and management of thrombocytopenia among NICUs and whether platelet administration had any effect on the incidence of IVH.…”

Section: Introductionmentioning

confidence: 99%

Inter-NICU Variation in Rates and Management of Thrombocytopenia among Very Low Birth-Weight Infants

2003

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OBJECTIVES:To investigate variation among neonatal intensive care units (NICUs) in prevalence and management of thrombocytopenia in infants <1500 g. STUDY DESIGN:In total 1283 infants <1500 g admitted to six NICUs over 21 months were prospectively analyzed. Illness severity was measured by the Score for Neonatal Acute Physiology (SNAP). Platelet counts in the first 12 hours after birth and on day 3 of life were abstracted from the infants' medical records. Thrombocytopenia was determined from the lowest platelet count in each of these time periods. RESULTS:There was variability in rates of thrombocytopenia among NICUs, even after controlling for risk factors (e.g., SNAP, small for gestational (SGA) age and maternal hypertension). One site had a high prevalence of thrombocytopenia, but the lowest percentage of infants with thrombocytopenia who received platelet transfusions. After controlling for SNAP, GA, SGA, Apgar score and incidence of thrombocytopenia, the odds of receiving platelets at this site, relative to the site with the highest transfusion rate, was 0.10 (95% CI 0.02 to 0.43). CONCLUSIONS:This multicenter study finds a 10-fold variation among NICU in the administration of platelets to their thrombocytopenic infants that cannot be explained by presence of thrombocytopenia or illness severity.

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Variation Among Neonatal Intensive Care Units in Narcotic Administration

Cited by 61 publications

References 29 publications

Freqüência do emprego de analgésicos em unidades de terapia intensiva neonatal universitárias

Freqüência do emprego de analgésicos em unidades de terapia intensiva neonatal universitárias

Pharmacological approaches to the management of pain in the neonatal intensive care unit

Inter-NICU Variation in Rates and Management of Thrombocytopenia among Very Low Birth-Weight Infants

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