Department of Pharmacy Services, University of California, Davis Health, Sacramento, CA.
Department of Public Health Services, Division of Biostatistics, Clinical and Translational Science Center, University of California, Sacramento, CA.
Pediatr Crit Care Med. 2018 Aug;19(8):e403-e408. doi: 10.1097/PCC.0000000000001601.
Methadone is often used in pediatric patients to prevent or treat opioid withdrawal after prolonged sedation. Prolonged corrected QT interval is an important adverse effect of methadone because it can progress to torsades de pointes, a potentially fatal dysrhythmia. The prevalence of corrected QT interval prolongation and contributing risk factors are not well defined in hospitalized pediatric patients receiving methadone. The study purpose was to identify the frequency and risk factors of corrected QT interval prolongation in hospitalized pediatric patients receiving methadone.
Retrospective cohort study.
Tertiary academic pediatric hospital, University of California Davis Children's Hospital, Sacramento, CA.
Cohort of 89 pediatric patients (birth to 18 yr) who received at least one dose of methadone while hospitalized.
Retrospective data over 7.5 years were obtained from the electronic health record.
From the cohort, 45 patients (50.6%) had documented corrected QT interval prolongation (≥ 450 ms) during the study period. No episodes of torsades de pointes were identified. In univariate analyses, higher maximum methadone doses were associated with a prolonged corrected QT interval (0.98 vs 0.59 mg/kg/d; odds ratio, 2.56; 1.15-5.70). Corrected QT interval prolongation occurred more frequently in patients with cardiac disease (63% vs 41%; p = 0.10). No factors were statistically significant in the multivariate analysis.
In hospitalized pediatric patients receiving methadone, corrected QT interval prolongation was common, but no episodes of torsades de pointes were documented. Risk factors that have been identified in adults were not associated with prolongation in our study population.
美沙酮常用于小儿患者，以预防或治疗长时间镇静后阿片类药物戒断。校正 QT 间期延长是美沙酮的一个重要不良反应，因为它可能进展为尖端扭转型室性心动过速，一种潜在的致命性心律失常。接受美沙酮治疗的住院儿科患者中，校正 QT 间期延长的发生率及其相关危险因素尚未明确界定。本研究的目的是确定接受美沙酮治疗的住院儿科患者校正 QT 间期延长的频率和危险因素。
回顾性队列研究。
加利福尼亚大学戴维斯分校儿童医院，萨克拉门托，加利福尼亚州。
接受至少一剂美沙酮治疗的 89 名儿科患者（出生至 18 岁）的队列。
在 7.5 年的时间里，从电子健康记录中获得了回顾性数据。
在该队列中，45 名患者（50.6%）在研究期间出现了校正 QT 间期延长（≥450ms）。未发现尖端扭转型室性心动过速发作。在单因素分析中，较高的美沙酮最大剂量与校正 QT 间期延长相关（0.98 比 0.59mg/kg/d；比值比，2.56；1.15-5.70）。患有心脏病的患者校正 QT 间期延长更常见（63%比 41%；p=0.10）。多因素分析中无统计学意义的因素。
在接受美沙酮治疗的住院儿科患者中，校正 QT 间期延长很常见，但未记录到尖端扭转型室性心动过速发作。在本研究人群中，成人中确定的危险因素与延长无关。
