323 - Utilization of Analgesia, Sedation, and Psychotropic Medications in the Intermountain Health Neonatal Intensive Care Units

Publication Number: 323.7065

Daley Owens, University of Utah School of Medicine, West Valley City, UT, United States; Jared Olson, University of Utah School of Medicine, Salt Lake City, UT, United States; Timothy M. Bahr, University of Utah, Provo, UT, United States; Shelley M.. Lawrence, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Many neonatal intensive care units (NICUs) have observed a rise in treatments for analgesic, sedative, and psychotropic medications despite lack of evidence-based data regarding their safety and efficacy. Emerging indications, such as neonatal delirium, have arisen despite its poorly understood pathophysiology. Variabilities of medication use in the NICU raises important questions about the impact of these pharmaceuticals on neurodevelopmental outcomes, mortality, and morbidity in this highly vulnerable population. This retrospective, descriptive study marks an initial effort to detail Intermountain Health practitioners' use of analgesic, sedative, and psychotropic medications in the NICU.

Objective: Describe analgesic, sedative, and psychotropic medication use in Intermountain NICUs.

Design/Methods: This study examined exposure to 15 drugs of interest in a retrospective cohort of all neonates admitted to Intermountain Health NICUs between 2018 and 2023. This IRB-approved study obtained data from the Intermountain Health Enterprise Data Warehouse by an authorized analyst (J.O.). We categorized the drugs of interest as opioids, sedatives, or psychotropics.Time series linear regression characterized the demographics of exposed infants and analyzed medication use over time.All data analyses were completed in R.

Results: Between 2018 and 2023, 17159 infants were admitted to Intermountain Health NICUs. Five thousand sixty-four (30%) were exposed to at least one of the drugs of interest. Any exposure was inversely associated with birthweight and length of stay (p < 0.001) but not with sex, race, or mortality. Exposure to opioids was most common (25%), followed by sedatives (22%) and psychotropic medications (3%).The largest statistically significant rise in exposure rates was seen with Dexmedetomidine (88% increase), Ketamine (81% increase), and Fentanyl (59% increase), while rates of use of Lorazepam, Midazolam, and Pentobarbital were greatly decreased.

Conclusion(s): The significant increases in Dexmedetomidine, Ketamine, and Fentanyl use suggest evolving practice among NICU practitioners, while the decline in Lorazepam, Midazolam, and Pentobarbital reflects a shift away from traditional therapies.These trends highlight the changing landscape of pharmacologic management in the NICU and emphasize the need for clinical trials to determine the safety, efficacy, and long-term neurodevelopmental outcomes associated with exposure to these drugs.This approach will facilitate the advancement of contemporary treatment strategies for neonatal pain, agitation, and treatment-related complications such as delirium.

Frequency of drug opioid, sedative, and psychotropic medication exposure by year in infants admitted to Intermountain Health NICUs.
WSPR graph.pdfOver the past six years, there has been a notable increase in the use of Morphine, Lorazepam, Dexmedetomidine, and Fentanyl, alongside a decrease in Midazolam usage.