Neonatal Netw. 2021 Mar 1;40(2):103-112. doi: 10.1891/0730-0832/11-T-727.
Delirium is a frequent complication of critical illness in adult and pediatric populations and is associated with significant morbidity and mortality. Little is known about the incidence, risk, symptoms, or treatment of delirium in the NICU. Only 4 cases of NICU delirium have been reported, but many pediatric studies include infants. The Cornell Assessment of Pediatric Delirium tool has been validated in neonatal and infant populations for identification of delirium. Initial treatment should focus on identification and reversal of the cause, with pharmacologic management reserved for patients with symptoms that do not resolve or that significantly impact medical care. Routine use of intravenous haloperidol should be avoided because of the high incidence of serious adverse effects, but it may be considered in patients with significant symptoms who are unable to take oral medications. Atypical antipsychotics (olanzapine, quetiapine, and risperidone) appear to be efficacious with a low incidence of adverse effects. Risperidone has weight-based dosing and a liquid dosage form available, making it a good option for use in the NICU. Additional data from large cohorts of NICU patients routinely screened for delirium, and treated as indicated, are needed.
谵妄是成人和儿科人群中重症疾病的常见并发症，与显著的发病率和死亡率相关。关于新生儿重症监护病房（NICU）中谵妄的发生率、风险、症状或治疗方法知之甚少。仅有 4 例 NICU 谵妄的报道，但许多儿科研究都包括了婴儿。康奈尔儿科谵妄评估工具已在新生儿和婴儿人群中得到验证，可用于识别谵妄。初始治疗应侧重于确定和逆转病因，对于症状未缓解或严重影响医疗护理的患者，保留药物治疗。由于严重不良反应的发生率高，应避免常规使用静脉注射氟哌啶醇，但对于无法口服药物的有明显症状的患者，可考虑使用。非典型抗精神病药（奥氮平、喹硫平和利培酮）似乎有效，不良反应发生率低。利培酮有基于体重的剂量和液体剂型，是 NICU 中使用的一个很好的选择。需要对经常筛查谵妄并根据需要进行治疗的大量 NICU 患者进行进一步的研究。
