WIP 21 - The Burden of Medical Intervention and Pain in Extremely Premature Infants

Publication Number: WIP 21.7569

Samantha Millikan, Vanderbilt University Medical Center, Nashville, TN, United States; Alexander G. Agthe, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Tracy Hills, Monroe Carell Jr Childen's Hospital at Vanderbilt, Nashv, TN, United States; Maria Gillam-Krakauer, Vanderbilt University School of Medicine, Nashvillt, TN, United States; Uchenna Anani, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States

Background: In recent years, the field of neonatology has made many advances in the care provided to neonates born extremely premature. Ongoing discussions surround offering life sustaining treatment to infants born at the border of viability. Concerns exist that extremely premature infants undergo pain and suffering during their stay in the Neonatal Intensive Care Unit (NICU). There is a fine balance that exists between providing these fragile neonates with life prolonging interventions and limiting discomfort. This study looks to understand the pain and procedural burden experienced by extremely premature infants to provide more informed counseling to families and information to help guide NICU care teams.

Objective: The purpose of this study is to quantify the pain and procedural burden of extremely premature infants who die compared to those who survive to NICU discharge.

Design/Methods: This is a single center retrospective case-control study approved by the Vanderbilt IRB. The control group includes infants born < 28 0/7 weeks gestation admitted to the Vanderbilt NICU between January 2018 and December 2023 that died during their NICU admission. Each of the control patients are matched using a one-to-one ratio with an extremely premature infant of similar gestational age and weight that survived to hospital discharge from the NICU during the study period. The primary outcomes are Neonatal Pain, Agitation, and Sedation Scale (N-PASS) scores and the number of painful/uncomfortable procedures experienced during NICU admission. Secondary outcomes include details of code events experienced and support services provided to each infant. Data has been collected through retrospective chart review of the electronic medical record. Comparisons of the two study groups will be done using descriptive statistics and logistic regression models. Collection and analysis of the data will be completed by December 2024.