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Delirium in the Neonate
Samuel J Adams1, Alicia Sprecher2
1Neurology - Child Neurology, Medical College of Wisconsin, Children's Wisconsin, 8915 W. Connell Cţ Milwaukee, WI 53226, USA.
Insights
Neonatal intensive care unit delirium is often unrecognized. Early detection using scoring systems and management with nonpharmacologic measures, atypical antipsychotics, or α-2 agonists can improve infant outcomes.
Area of Science:
- Neonatal intensive care
- Pediatric critical care
- Neuroscience
Background:
- Delirium is a significant concern in the neonatal intensive care unit (NICU).
- It is frequently underrecognized in critically ill infants.
- Risk factors include illness severity, neurosedative medication use, and environmental disruptions.
Purpose of the Study:
- To highlight the prevalence and risk factors of delirium in the NICU.
- To emphasize the importance of delirium detection and management strategies.
- To review potential pharmacologic interventions for NICU delirium.
Main Methods:
- Review of existing pediatric evidence on neonatal delirium.
- Discussion of risk factors and diagnostic challenges.
- Exploration of management strategies, including nonpharmacologic and pharmacologic options.
Main Results:
- Delirium is likely prevalent in NICU infants but often missed.
- Illness severity, neurosedative exposure, and environmental factors increase risk.
- Scoring systems can aid detection; management involves addressing causes and nonpharmacologic measures.
Conclusions:
- Regular use of delirium scoring systems is recommended for improved detection in NICU settings.
- Management should prioritize addressing underlying causes and implementing nonpharmacologic interventions.
- Atypical antipsychotics and α-2 agonists show promise as adjunctive treatments for delirium and neurosedative weaning.
Abstract:
Delirium is likely present in the neonatal intensive care unit and has been largely unrecognized. There are several risk factors for delirium including illness severity, neurosedative exposure, and environmental disruptions that put infants at risk for delirium. Regular use of scoring systems should be considered to improve delirium detection. When identified, initial steps in management should include resolving underlying causes and implementation of standard nonpharmacologic measures. Mounting pediatric evidence suggests that the atypical antipsychotics, as well as the α-2 agonists, may be additionally beneficial in treating delirium as well as improving the ability to wean off other neurosedative medications.
