Agitation in the NICU: is this Neonatal Delirium or something else?

Chair(s)

• 

  Raul Chavez-Valdez, MD (he/him/his)

  Associate Professor
  Pediatrics
  Johns Hopkins University School of Medicine
  Baltimore, Maryland, United States

Delirium is an acute neuropsychiatric disorder with significant disturbances in attention, awareness and cognition. The developing brain of a neonate admitted for a prolonged period of time in the NICU is subject to the impact of multiple comorbidities, interventions and noxious stimuli. Thus, identification of an acute cerebral disorder and exclusion of a prior cognitive impairment, both diagnostic criteria of delirium, are cumbersome. This is particularly difficult in an aging premature infant developing symptoms mimicking delirium, as characterized in older children and adults. As the developmental needs for social interaction increase in premature infants, they may also develop restlessness and agitation, which are further complicated by common treatments reversing their sleep/wake cycle. Furthermore, in neonates many of the biochemical substrates and structural connections needed to develop delirium are yet to be developed. One of the most serious complications of diagnosing neonatal "delirium" is that, in certain instances, anti-psychotic medications are initiated. These drugs modulate many of the same neurotransmitter systems essential for brain development. In this state-of-the-art plenary, we will discuss cutting-edge research about: a) dynamics in neurotransmitter systems and regional connectome development, b) impact of chronic morbidities during brain development leading to agitation as premature infants age, c) management of agitation/restlessness in premature infants as they age and d) consequences of the use of anti-psychotics in this vulnerable population, with an aim to incentivize a discussion that translates to the clinical management of this very complex and common problem.

Presentations:

• 9:15am – 9:20am HST

  Agitation in the NICU: Is This Neonatal Delirium or Something Else? - Introduction
  

  Speaker: Frances Northington, MD – Johns Hopkins University School of Medicine
• 9:20am – 9:35am HST

  Neurotransmitter Systems and Regional Connectome During Brain Development
  

  Speaker: Adam L. Numis, MD (he/him/his) – University of California, San Francisco
• 9:35am – 9:45am HST

  Impact of Chronic Morbidities During Early Brain Development Leading to Agitation and Restlessness - Concepts
  

  Speaker: Raul Chavez-Valdez, MD (he/him/his) – Johns Hopkins University School of Medicine
• 9:45am – 9:50am HST

  Defining neuroirritabiity in the older preterm infant.
  

  Speaker: April Sharp, MD (she/her/hers) – Kennedy Krieger/Johns Hopkins
• 9:50am – 10:00am HST

  Non-pharmacological and Pharmacological Interventions to Treat Agitation in Premature Infants as They Develop - Part 1
  

  Speaker: Vera Joanna Burton, MD/PhD – Kennedy Krieger Institute
• 10:00am – 10:10am HST

  Non-pharmacological and Pharmacological Interventions to Treat Agitation in Premature Infants as They Develop - Part 2
  

  Speaker: Gwendolyn Gerner, PsyD (she/her/hers) – Kennedy Krieger Institute
• 10:10am – 10:25am HST

  Anti-psychotics in Neonates , Is It a Good Idea?
  

  Speaker: Lauren Jantzie, PhD (she/her/hers) – Johns Hopkins University School of Medicine
• 10:25am – 10:45am HST

  Q & A