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Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
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Standardizing morphine use for ventilated preterm neonates with a nursing-driven comfort protocol.

R Fleishman1, C Zhou2, C Gleason3

  • 1Division of Neonatology, St Christopher's Hospital for Children, Philadelphia, PA, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|July 25, 2014
PubMed
Summary

A nursing-driven comfort protocol significantly reduced non-standard morphine (N-SM) use in a neonatal intensive care unit (NICU). Reduced N-SM was linked to better clinical outcomes, including shorter ventilation and total parenteral nutrition (TPN) durations.

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Area of Science:

  • Neonatal intensive care
  • Pediatric pharmacology
  • Nursing-driven interventions

Background:

  • Non-standard morphine (N-SM) use in neonatal intensive care units (NICUs) can negatively impact clinical outcomes.
  • Standardizing pain management protocols is crucial for improving neonatal care.

Purpose of the Study:

  • To evaluate the impact of a nursing-driven comfort protocol on standardizing morphine use in a NICU.
  • To investigate the association between N-SM use and key clinical outcomes such as ventilation duration, total parenteral nutrition (TPN) duration, and length of stay (LOS).

Main Methods:

  • A retrospective/prospective observational study was conducted using pharmacy and medical records.
  • The study compared N-SM use before and after implementing a comfort protocol in preterm, ventilated neonates (<1500 grams).
  • Statistical-process control analysis and multivariable linear regression were used to assess N-SM use and clinical outcomes.

Main Results:

  • Implementation of the comfort protocol decreased the proportion of patients receiving N-SM from 59% to 35% (P = 0.017).
  • Each additional day of N-SM use was associated with increased days of ventilation (0.47 days) and TPN (0.52 days).
  • Exposure to N-SM was linked to a 17-day increase in hospitalization length of stay (LOS).

Conclusions:

  • A nursing-driven comfort protocol effectively reduced N-SM use in the NICU.
  • N-SM use is negatively associated with critical clinical outcomes in neonates.
  • Further investigation of similar protocols in diverse clinical settings is recommended.