Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.250, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.250, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
J Pediatr Surg. 2021 Jul;56(7):1113-1116. doi: 10.1016/j.jpedsurg.2021.03.030. Epub 2021 Mar 26.
Repetitive painful stimuli and early exposure to opioids places neonates at risk for neurocognitive delays. We aimed to understand opioid utilization for neonates with gastroschisis.
We performed a retrospective review of infants with gastroschisis at a tertiary children's hospital (2017-2019). Multivariate linear regression was performed to analyze variations in opioid use.
Among 30 patients with gastroschisis, 33% were managed by primary suture-less closure, 7% by primary sutured closure, 40% by spring silo, and 20% by handsewn silo. The proportion of pain medication used was: morphine (89%), acetaminophen (8%), and fentanyl (3%). Opioids were used for a median of 6.5 days (range 0-20) per patient. Median total opioid administered across all patients was 2.2 morphine milligram equivalents (MME)/kg (IQR 0.7-3.3). Following definitive closure, median opioid use was 0.2 MME/kg (IQR 0.1-0.8). With multivariate regression, 45% of the variation in MME use was associated with the type of surgery after adjusting for weight, gestational age, and gender, p = 0.02. After definitive fascial closure, there was no significant variations in opioid use.
There is a significant variation in the utilization of opioid, primarily prior to fascial closure. Understanding pain needs and standardization may improve opioid stewardship in infants with gastroschisis. 197/200 LEVEL OF EVIDENCE: Level III.
重复的疼痛刺激和早期接触阿片类药物会使新生儿面临神经认知延迟的风险。我们旨在了解先天性腹壁裂患儿中阿片类药物的使用情况。
我们对一家三级儿童医院（2017-2019 年）的先天性腹壁裂患儿进行了回顾性研究。采用多元线性回归分析来分析阿片类药物使用的变化。
在 30 例先天性腹壁裂患儿中，33%的患儿采用一期无张力缝合关闭，7%的患儿采用一期缝合关闭，40%的患儿采用 Spring 造口袋，20%的患儿采用手工造口袋。使用的止痛药物比例为：吗啡（89%）、对乙酰氨基酚（8%）和芬太尼（3%）。中位数每个患者使用阿片类药物 6.5 天（范围 0-20 天）。所有患者的中位数总阿片类药物用量为 2.2 吗啡毫克当量（MME）/kg（IQR 0.7-3.3）。在确定性关闭后，中位数阿片类药物用量为 0.2 MME/kg（IQR 0.1-0.8）。在进行多元回归分析后，调整体重、胎龄和性别后，手术类型与 MME 使用量的 45%差异相关，p=0.02。在确定性筋膜闭合后，阿片类药物的使用没有显著差异。
在使用阿片类药物方面存在显著差异，主要是在筋膜闭合之前。了解疼痛需求和标准化可能会改善先天性腹壁裂患儿的阿片类药物管理。197/200 证据水平：III 级。
