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Variation in opioid utilization among neonates with gastroschisis
Linda T Li1, Nutan B Hebballi2, Eric W Reynolds3
1Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.250, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
Insights
Opioid use in neonates with gastroschisis varies significantly, especially before surgical closure. Standardizing pain management may improve opioid stewardship in these infants.
Area of Science:
- Neonatal surgery
- Pediatric pharmacology
- Pain management
Background:
- Neonates undergoing surgery face risks of neurocognitive delays from painful stimuli and early opioid exposure.
- Gastroschisis, a congenital abdominal wall defect, often requires surgical intervention and pain management.
Purpose of the Study:
- To investigate opioid utilization patterns in neonates diagnosed with gastroschisis.
- To identify factors influencing opioid use in this vulnerable population.
Main Methods:
- Retrospective review of 30 infants with gastroschisis treated between 2017-2019.
- Multivariate linear regression analysis to assess variations in opioid administration (measured in MME/kg).
Main Results:
- Morphine was the predominant opioid (89%), with a median use of 6.5 days.
- Surgical approach accounted for 45% of the variation in opioid use (p=0.02), particularly before fascial closure.
- Opioid use significantly decreased after definitive fascial closure.
Conclusions:
- Significant variability exists in opioid utilization among neonates with gastroschisis, primarily before surgical repair.
- Understanding and standardizing pain management strategies are crucial for improving opioid stewardship.
- Further research can optimize pain control and minimize long-term neurocognitive risks.
Purpose:
Repetitive painful stimuli and early exposure to opioids places neonates at risk for neurocognitive delays. We aimed to understand opioid utilization for neonates with gastroschisis.
Methods:
We performed a retrospective review of infants with gastroschisis at a tertiary children's hospital (2017-2019). Multivariate linear regression was performed to analyze variations in opioid use.
Results:
Among 30 patients with gastroschisis, 33% were managed by primary suture-less closure, 7% by primary sutured closure, 40% by spring silo, and 20% by handsewn silo. The proportion of pain medication used was: morphine (89%), acetaminophen (8%), and fentanyl (3%). Opioids were used for a median of 6.5 days (range 0-20) per patient. Median total opioid administered across all patients was 2.2 morphine milligram equivalents (MME)/kg (IQR 0.7-3.3). Following definitive closure, median opioid use was 0.2 MME/kg (IQR 0.1-0.8). With multivariate regression, 45% of the variation in MME use was associated with the type of surgery after adjusting for weight, gestational age, and gender, p = 0.02. After definitive fascial closure, there was no significant variations in opioid use.
Conclusion:
There is a significant variation in the utilization of opioid, primarily prior to fascial closure. Understanding pain needs and standardization may improve opioid stewardship in infants with gastroschisis. 197/200 LEVEL OF EVIDENCE: Level III.
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