Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia

Mark F. Weems; Theresa R. Grover; Ruth Seabrook; Robert DiGeronimo; Jason Gien; Sarah Keene; Natalie Rintoul; John M. Daniel; Yvette Johnson; Yigit Guner; Isabella Zaniletti; Karna Murthy; the Children's Hospitals Neonatal Consortium Congenital Diaphragmatic Hernia Focus Group

doi:10.1055/s-0041-1729877

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(04): 415-423
DOI: 10.1055/s-0041-1729877

Original Article

Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia

Mark F. Weems

¹Division of Neonatology, Department of Pediatrics, Le Bonheur Children's Hospital and the University of Tennessee Health Science Center, Memphis, Tennessee

,

Theresa R. Grover

²Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado

,

Ruth Seabrook

³Nationwide Children's Hospital, Columbus, Ohio

,

Robert DiGeronimo

⁴Seattle Children's Hospital and University of Washington, Seattle, Washington

,

Jason Gien

²Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado

,

Sarah Keene

⁵Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, Georgia

,

Natalie Rintoul

⁶Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

,

John M. Daniel

⁷Department of Pediatrics, Children's Mercy Hospitals & Clinics, University of Missouri Kansas, Kansas City, Missouri

,

Yvette Johnson

⁸Department of Neonatology, Cook Children's Hospital, Fort Worth, Texas

,

Yigit Guner

⁹Children's Hospital of Orange County and University of California Irvine, Orange, California

,

Isabella Zaniletti

¹⁰Children's Hospital Association, Lenexa, Kansas

,

Karna Murthy

¹¹Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

,

the Children's Hospitals Neonatal Consortium Congenital Diaphragmatic Hernia Focus Group

› Author Affiliations

Abstract

Objective The aim of this study was to describe the use, duration, and intercenter variation of analgesia and sedation in infants with congenital diaphragmatic hernia (CDH).

Study Design This is a retrospective analysis of analgesia, sedation, and neuromuscular blockade use in neonates with CDH. Patient data from 2010 to 2016 were abstracted from the Children's Hospitals Neonatal Database and linked to the Pediatric Health Information System. Patients were excluded if they also had non-CDH conditions likely to affect the use of the study medications.

Results A total of 1,063 patients were identified, 81% survived, and 30% were treated with extracorporeal membrane oxygenation (ECMO). Opioid (99.8%), sedative (93.4%), and neuromuscular blockade (87.9%) use was common. Frequency of use was higher and duration was longer among CDH patients treated with ECMO. Unadjusted duration of use varied 5.6-fold for benzodiazepines (median: 14 days) and 7.4-fold for opioids (median: 16 days). Risk-adjusted duration of use varied among centers, and prolonged use of both opioids and benzodiazepines ≥5 days was associated with increased mortality (p < 0.001) and longer length of stay (p < 0.001). Use of sedation or neuromuscular blockade prior to or after surgery was each associated with increased mortality (p ≤ 0.01).

Conclusion Opioids, sedatives, and neuromuscular blockade were used commonly in infants with CDH with variable duration across centers. Prolonged combined use ≥5 days is associated with mortality.

Key Points

Use of analgesia and sedation varies across children's hospital NICUs.
Prolonged opioid and benzodiazepine use is associated with increased mortality.
Postsurgery sedation and neuromuscular blockade are associated with mortality.

Keywords

opioid - benzodiazepine - paralytic - surgery - neonates - pain - CHND - ECMO

Full Text

References

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