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Updated: Jan 23, 2026
Neonatal Cardiac Scaffolds: Novel Matrices for Regenerative Studies
Published on: November 5, 2016
Preliminary evaluation of a developmentally centred approach to optimise comfort in neonates following cardiac
Melissa B Jones1, Sherrill D Caprarola2, Heather Gordish3
1Division of Cardiac Critical Care, https://ror.org/03wa2q724Children's National Hospital, Washington, DC, USA.
Insights
The Comfort Curriculum significantly reduced opioid use in neonates after heart surgery without increasing pain. This intervention aids in managing pain and opioid exposure in vulnerable infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Neurodevelopmental Outcomes
Background:
- Children with congenital heart disease (CHD) face risks of neurodevelopmental impairments.
- Neonatal pain and opioid exposure can negatively impact brain development.
Purpose of the Study:
- To assess the impact of a Comfort Curriculum on opioid exposure in neonates post-cardiac surgery.
- To evaluate the effect of the Comfort Curriculum on neonatal pain scores within the first 5 days after surgery.
Main Methods:
- A retrospective cohort study analyzed cardiac surgical patients (≤30 days old) before and after Comfort Curriculum implementation.
- The Comfort Curriculum included a standardized sedation pathway, non-pharmacologic pain management, and holding guidelines.
- Data were collected at baseline, 3 months, and 15 months post-implementation.
Main Results:
- Initial and maximum opioid infusion rates significantly decreased post-implementation.
- Total cumulative opioid doses showed a non-significant decrease in the first 5 post-operative days.
- Pain scores did not increase, with a trend towards decrease observed.
Conclusions:
- The Comfort Curriculum led to a significant reduction in initial and maximum opioid doses.
- A trend towards reduced total opioid use was observed in the early post-operative period.
- The findings suggest the Comfort Curriculum is effective in managing opioid exposure in neonatal cardiac surgery.
Introduction:
Children with CHD are at risk for neurodevelopmental impairments, and though these are often mild, some children face severe developmental challenges. Both unalleviated pain and exposure to opioids in the neonatal period have detrimental effects on the developing brain.
Method:
We developed and implemented a Comfort Curriculum including a standardised sedation pathway, bedside non-pharmacologic reference, and holding guidelines. Our primary aim was to assess the effect of the Comfort Curriculum on opioid exposure. The secondary aim was to assess the effect of the Comfort Curriculum on pain scores in neonates in the first 5 days after surgery. A retrospective cohort study of all cardiac surgical patients ≤30 days of age at the time of their first operation was conducted before and at two points after implementation of the Comfort Curriculum (3 months and 15 months).
Results:
We found that initial and maximum opioid infusion rates significantly decreased between the pre-implementation and both post-implementation phases, while pain scores did not increase. The total cumulative opioid doses in the first five post-operative days showed a non-statistically significant decrease in both post-implementation phases compared to the pre-implementation phase, and median pain scores showed a trend towards decreasing in both post-implementation phases.
Discussion:
After implementation of the Comfort Curriculum, we found a significant decrease in the initial and maximum opioid doses and a signal towards a reduction in total opioid dose in the first 5 days after neonatal cardiac surgery.
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