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Gabapentin for Delirium in Infants in the Neonatal Intensive Care Unit
Eugenie Chang1, Avery Parman2, Peter N Johnson2
1Department of Pharmacy (EC), Bethany Children's Health Center, Oklahoma City, OK.
Summary
Gabapentin effectively managed neonatal intensive care unit (NICU) delirium in most cases, reducing pain and withdrawal symptoms. This study highlights gabapentin
Area of Science:
- Neonatal pharmacology and intensive care.
- Pediatric neurology and critical care medicine.
- Delirium management in vulnerable populations.
Background:
- Neonatal intensive care unit (NICU) delirium presents a significant clinical challenge.
- A structured protocol involving gabapentin, melatonin, and antipsychotics was developed for NICU delirium management.
- Understanding the specific utility and optimal dosing of gabapentin in this population is crucial.
Purpose of the Study:
- To describe the clinical utility and precise dosing strategies of gabapentin for managing delirium in NICU patients.
- To evaluate gabapentin's role as a first-line (Step 1) or second-line (Step 2) agent within the established NICU delirium protocol.
- To assess the need for escalation to third-line treatments, such as antipsychotics.
Main Methods:
- Retrospective analysis of 29 NICU patients receiving gabapentin for delirium between January 2021 and December 2022.
- Data collected included patient demographics, gabapentin dosage regimens, and concurrent sedative/analgesic use.
- Evaluated changes in pain (EDIN), delirium (CAPD), and withdrawal (WAT-1) scores, alongside medication usage, pre- and post-gabapentin initiation.
Main Results:
- Gabapentin was utilized as a Step 1 treatment in 75.9% of patients; no patients required Step 3 antipsychotic therapy.
- The median initial gabapentin dose was 14.4 mg/kg/day, with 41.4% requiring dose escalation.
- Significant reductions in pain (EDIN) and withdrawal (WAT-1) scores were observed, while delirium (CAPD) scores and other medication doses remained unchanged.
Conclusions:
- Gabapentin is frequently used as an initial therapy for NICU delirium, typically at a median dose around 14 mg/kg/day.
- The administration of gabapentin correlated with a significant decrease in neonatal pain and withdrawal symptoms.
- Gabapentin demonstrates utility in managing NICU delirium, potentially reducing the need for more potent interventions.
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