Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia

Mark F. Weems; Theresa R. Grover; Ruth Seabrook; Robert Digeronimo; Jason Gien; Sarah Keene; Natalie Rintoul; John M. Daniel; Yvette Johnson; Yigit Guner; Isabella Zaniletti; Karna Murthy

doi:10.1055/s-0041-1729877

Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia

Mark F. Weems^*, Theresa R. Grover, Ruth Seabrook, Robert Digeronimo, Jason Gien, Sarah Keene, Natalie Rintoul, John M. Daniel, Yvette Johnson, Yigit Guner, Isabella Zaniletti, Karna Murthy

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Objective The aim of this study was to describe the use, duration, and intercenter variation of analgesia and sedation in infants with congenital diaphragmatic hernia (CDH). Study Design This is a retrospective analysis of analgesia, sedation, and neuromuscular blockade use in neonates with CDH. Patient data from 2010 to 2016 were abstracted from the Children's Hospitals Neonatal Database and linked to the Pediatric Health Information System. Patients were excluded if they also had non-CDH conditions likely to affect the use of the study medications. Results A total of 1,063 patients were identified, 81% survived, and 30% were treated with extracorporeal membrane oxygenation (ECMO). Opioid (99.8%), sedative (93.4%), and neuromuscular blockade (87.9%) use was common. Frequency of use was higher and duration was longer among CDH patients treated with ECMO. Unadjusted duration of use varied 5.6-fold for benzodiazepines (median: 14 days) and 7.4-fold for opioids (median: 16 days). Risk-adjusted duration of use varied among centers, and prolonged use of both opioids and benzodiazepines ≥5 days was associated with increased mortality (p < 0.001) and longer length of stay (p < 0.001). Use of sedation or neuromuscular blockade prior to or after surgery was each associated with increased mortality (p ≤ 0.01). Conclusion Opioids, sedatives, and neuromuscular blockade were used commonly in infants with CDH with variable duration across centers. Prolonged combined use ≥5 days is associated with mortality. Key Points Use of analgesia and sedation varies across children's hospital NICUs. Prolonged opioid and benzodiazepine use is associated with increased mortality. Postsurgery sedation and neuromuscular blockade are associated with mortality.

Original language	English (US)
Pages (from-to)	415-423
Number of pages	9
Journal	American journal of perinatology
Volume	40
Issue number	4
DOIs	https://doi.org/10.1055/s-0041-1729877
State	Published - Mar 1 2023

Funding

Funding This research is supported by a grant from the Fore Hadley Foundation (Dunwoody, GA). Acknowledgments The authors are indebted to the following institutions that serve the infants and their families, and these institutions have invested in and continue to participate in the Children's Hospitals Neonatal Database (CHND). The current site sponsors/contributors for the CHND are also included. They are as follows: 1. Children's Healthcare of Atlanta, Atlanta, GA (Anthony Piazza) 2. Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA (Gregory Sysyn) 3. Children's Hospital of Alabama, Birmingham, AL (Carl Coghill) 4. Le Bonheur Children's Hospital, Memphis, TN (Ajay Talati) 5. Children's Hospital Boston, Boston, MA (Anne Hansen, Tanzeema Houssain) 6. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia) 7. Cincinnati Children's Hospital, Cincinnati, OH (Beth Haberman) 8. Nationwide Children's Hospital, Columbus, OH (Kristina Reber) 9. Children's Medical Center, Dallas, TX (Rashmin Savani) 10. Children's Hospital Colorado, Aurora, CO (Theresa Grover) 11. Children's Hospital of Michigan, Detroit, MI (Girija Natarajan) 12. Cook Children's Health Care System, Fort Worth, TX (Annie Chi, Yvette Johnson) 13. Texas Children's Hospital, Houston, TX (Gautham Suresh) 14. Riley Children's Hospital, Indianapolis, IN (William Engle) 15. Children's Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto) 16. Arkansas Children's Hospital, Little Rock, AR (Robert Lyle, Becky Rogers) 17. Children's Hospital Los Angeles, Los Angeles, CA (Rachel Chapman) 18. American Family Children's Hospital, Madison, WI (Jamie Limjoco) 19. Children's Hospital & Research Center Oakland, Oakland, CA (Priscilla Joe) 20. The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula, David Munson) 21. St. Christopher's Hospital for Children, Philadelphia, PA (Suzanne Touch) 22. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Toby Yanowitz) 23. St. Louis Children's Hospital, St Louis, MO (Rakesh Rao, Beverly Brozanski) 24. All Children's Hospital, St. Petersburg, FL (Victor McKay) 25. Rady Children's Hospital, San Diego, CA (Mark Speziale, Laurel Moyer) 26. Children's National Medical Center, Washington, DC (Billie Short) 27. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan) 28. Primary Children's Medical Center, Salt Lake City, UT (Con Yee Ling) 29. Children's Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta) 30. Children's Hospital of Omaha, Omaha, NE (Lynne Willett, Nicole Birge) 31. AdventHealth for Children, Orlando, FL (Rajan Wadhawan) 32. Seattle Children's Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert DiGeronimo) 33. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee) 34. Children's Hospital Orange County, Los Angeles, CA (Michel Mikhael) 35. Connecticut Children's Hospital, Hartford, CT (James Moore) 36. Nemour's Children's Hospital, Orlando, FL (Darlene Calhoun) 37. Brenner Children's Hospital, Wake Forest, NC (Cherrie Welch) Jeanette Asselin, Beverly Brozanski, David Durand (ex officio), Francine Dykes (ex officio), Jacquelyn Evans (Executive Director), Theresa Grover, Karna Murthy (Chair), Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber, and Billie Short are members of the Children's Hospitals Neonatal Consortium, Inc. For more information, please contact [email protected]. This research is supported by a grant from the Fore Hadley Foundation (Dunwoody, GA).

Keywords

CHND
ECMO
benzodiazepine
neonates
opioid
pain
paralytic
surgery

ASJC Scopus subject areas

Obstetrics and Gynecology
Pediatrics, Perinatology, and Child Health

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title = "Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia",

abstract = "Objective The aim of this study was to describe the use, duration, and intercenter variation of analgesia and sedation in infants with congenital diaphragmatic hernia (CDH). Study Design This is a retrospective analysis of analgesia, sedation, and neuromuscular blockade use in neonates with CDH. Patient data from 2010 to 2016 were abstracted from the Children's Hospitals Neonatal Database and linked to the Pediatric Health Information System. Patients were excluded if they also had non-CDH conditions likely to affect the use of the study medications. Results A total of 1,063 patients were identified, 81% survived, and 30% were treated with extracorporeal membrane oxygenation (ECMO). Opioid (99.8%), sedative (93.4%), and neuromuscular blockade (87.9%) use was common. Frequency of use was higher and duration was longer among CDH patients treated with ECMO. Unadjusted duration of use varied 5.6-fold for benzodiazepines (median: 14 days) and 7.4-fold for opioids (median: 16 days). Risk-adjusted duration of use varied among centers, and prolonged use of both opioids and benzodiazepines ≥5 days was associated with increased mortality (p < 0.001) and longer length of stay (p < 0.001). Use of sedation or neuromuscular blockade prior to or after surgery was each associated with increased mortality (p ≤ 0.01). Conclusion Opioids, sedatives, and neuromuscular blockade were used commonly in infants with CDH with variable duration across centers. Prolonged combined use ≥5 days is associated with mortality. Key Points Use of analgesia and sedation varies across children's hospital NICUs. Prolonged opioid and benzodiazepine use is associated with increased mortality. Postsurgery sedation and neuromuscular blockade are associated with mortality.",

keywords = "CHND, ECMO, benzodiazepine, neonates, opioid, pain, paralytic, surgery",

author = "Weems, {Mark F.} and Grover, {Theresa R.} and Ruth Seabrook and Robert Digeronimo and Jason Gien and Sarah Keene and Natalie Rintoul and Daniel, {John M.} and Yvette Johnson and Yigit Guner and Isabella Zaniletti and Karna Murthy",

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language = "English (US)",

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T1 - Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia

AU - Weems, Mark F.

AU - Grover, Theresa R.

AU - Seabrook, Ruth

AU - Digeronimo, Robert

AU - Gien, Jason

AU - Keene, Sarah

AU - Rintoul, Natalie

AU - Daniel, John M.

AU - Johnson, Yvette

AU - Guner, Yigit

AU - Zaniletti, Isabella

AU - Murthy, Karna

PY - 2023/3/1

Y1 - 2023/3/1

N2 - Objective The aim of this study was to describe the use, duration, and intercenter variation of analgesia and sedation in infants with congenital diaphragmatic hernia (CDH). Study Design This is a retrospective analysis of analgesia, sedation, and neuromuscular blockade use in neonates with CDH. Patient data from 2010 to 2016 were abstracted from the Children's Hospitals Neonatal Database and linked to the Pediatric Health Information System. Patients were excluded if they also had non-CDH conditions likely to affect the use of the study medications. Results A total of 1,063 patients were identified, 81% survived, and 30% were treated with extracorporeal membrane oxygenation (ECMO). Opioid (99.8%), sedative (93.4%), and neuromuscular blockade (87.9%) use was common. Frequency of use was higher and duration was longer among CDH patients treated with ECMO. Unadjusted duration of use varied 5.6-fold for benzodiazepines (median: 14 days) and 7.4-fold for opioids (median: 16 days). Risk-adjusted duration of use varied among centers, and prolonged use of both opioids and benzodiazepines ≥5 days was associated with increased mortality (p < 0.001) and longer length of stay (p < 0.001). Use of sedation or neuromuscular blockade prior to or after surgery was each associated with increased mortality (p ≤ 0.01). Conclusion Opioids, sedatives, and neuromuscular blockade were used commonly in infants with CDH with variable duration across centers. Prolonged combined use ≥5 days is associated with mortality. Key Points Use of analgesia and sedation varies across children's hospital NICUs. Prolonged opioid and benzodiazepine use is associated with increased mortality. Postsurgery sedation and neuromuscular blockade are associated with mortality.

AB - Objective The aim of this study was to describe the use, duration, and intercenter variation of analgesia and sedation in infants with congenital diaphragmatic hernia (CDH). Study Design This is a retrospective analysis of analgesia, sedation, and neuromuscular blockade use in neonates with CDH. Patient data from 2010 to 2016 were abstracted from the Children's Hospitals Neonatal Database and linked to the Pediatric Health Information System. Patients were excluded if they also had non-CDH conditions likely to affect the use of the study medications. Results A total of 1,063 patients were identified, 81% survived, and 30% were treated with extracorporeal membrane oxygenation (ECMO). Opioid (99.8%), sedative (93.4%), and neuromuscular blockade (87.9%) use was common. Frequency of use was higher and duration was longer among CDH patients treated with ECMO. Unadjusted duration of use varied 5.6-fold for benzodiazepines (median: 14 days) and 7.4-fold for opioids (median: 16 days). Risk-adjusted duration of use varied among centers, and prolonged use of both opioids and benzodiazepines ≥5 days was associated with increased mortality (p < 0.001) and longer length of stay (p < 0.001). Use of sedation or neuromuscular blockade prior to or after surgery was each associated with increased mortality (p ≤ 0.01). Conclusion Opioids, sedatives, and neuromuscular blockade were used commonly in infants with CDH with variable duration across centers. Prolonged combined use ≥5 days is associated with mortality. Key Points Use of analgesia and sedation varies across children's hospital NICUs. Prolonged opioid and benzodiazepine use is associated with increased mortality. Postsurgery sedation and neuromuscular blockade are associated with mortality.

KW - CHND

KW - ECMO

KW - benzodiazepine

KW - neonates

KW - opioid

KW - pain

KW - paralytic

KW - surgery

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Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia

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