Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles.
JAMA Netw Open. 2023 Jun 1;6(6):e2318910. doi: 10.1001/jamanetworkopen.2023.18910.
Necrotizing enterocolitis (NEC) requiring surgical intervention is the most common reason for surgical procedures in preterm neonates. Opioids are used to manage postoperative pain, with some infants requiring methadone to treat physiologic opioid dependence or wean from nonmethadone opioid treatment during recovery.
To describe postoperative opioid use and methadone treatment for infants with surgically treated NEC and evaluate postoperative outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study of infants with surgically treated NEC admitted from January 1, 2013, to December 31, 2022, to 48 Children's Hospital Association hospitals contributing data to the Pediatric Health Information System (PHIS) was performed. Infants who received methadone preoperatively, were aged 14 days or less at the time of the operation, had a congenital heart disease-related operation, or died within 90 days of the operation were excluded. Mixed-effects multivariable logistic regression was used to evaluate thresholds for duration of opioid use after the operation associated with methadone treatment and clinical outcomes associated with methadone use were enumerated.
Postoperative administration of nonmethadone opioids.
Methadone use and postoperative length of stay, ventilator days, and total parenteral nutrition (TPN) days.
Of the 2037 infants with surgically treated NEC identified, the median birth weight was 920 (IQR, 700.0-1479.5) g; 1204 were male (59.1%), 911 were White (44.7%), and 343 were Hispanic (16.8%). Infants received nonmethadone opioids for a median of 15 (IQR, 6-30) days after the operation and 231 received methadone (11.3%). The median first day of methadone use was postoperative day 18 (IQR, days 9-64) and continued for 28 days (IQR, 14-73). Compared with infants who received nonmethadone opioids for 1 to 5 days, infants receiving 16 to 21 days of opioids were most likely to receive methadone treatment (odds ratio, 11.45; 95% CI, 6.31-20.77). Methadone use was associated with 21.41 (95% CI, 10.81-32.02) more days of postoperative length of stay, 10.80 (95% CI, 3.63-17.98) more ventilator days, and 16.21 (95% CI, 6.34-26.10) more TPN days.
In this cohort study of infants with surgically treated NEC, prolonged use of nonmethadone opioids after the operation was associated with an increased likelihood of methadone treatment and increased postoperative length of stay, ventilation, and TPN use. Optimizing postoperative pain management for infants requiring an operation may decrease the need for methadone treatment and improve health care use.
需要手术干预的坏死性小肠结肠炎（NEC）是早产儿最常见的手术原因。阿片类药物用于治疗术后疼痛，一些婴儿需要美沙酮来治疗生理性阿片类药物依赖或在康复期间从非美沙酮阿片类药物治疗中戒断。
描述接受手术治疗的 NEC 婴儿的术后阿片类药物使用和美沙酮治疗，并评估术后结果。
设计、地点和参与者：对 2013 年 1 月 1 日至 2022 年 12 月 31 日期间从 48 家儿童健康协会医院（向儿科健康信息系统（PHIS）提供数据）入院接受手术治疗的 NEC 婴儿进行了队列研究。排除了术前接受美沙酮、手术时年龄在 14 天或以下、患有先天性心脏病相关手术或术后 90 天内死亡的婴儿。使用混合效应多变量逻辑回归评估与美沙酮治疗相关的术后阿片类药物使用持续时间的阈值，并列举与美沙酮使用相关的临床结果。
术后给予非美沙酮类阿片类药物。
美沙酮的使用以及术后住院时间、呼吸机使用时间和全胃肠外营养（TPN）使用时间。
在 2037 名接受手术治疗的 NEC 婴儿中，中位出生体重为 920（IQR，700.0-1479.5）g；1204 名男性（59.1%），911 名白人（44.7%），343 名西班牙裔（16.8%）。婴儿在手术后接受非美沙酮类阿片类药物治疗的中位数为 15（IQR，6-30）天，其中 231 名婴儿接受了美沙酮治疗（11.3%）。美沙酮治疗的中位起始日为术后第 18 天（IQR，第 9-64 天），持续 28 天（IQR，第 14-73 天）。与接受 1 至 5 天阿片类药物治疗的婴儿相比，接受 16 至 21 天阿片类药物治疗的婴儿最有可能接受美沙酮治疗（比值比，11.45；95%CI，6.31-20.77）。美沙酮的使用与术后住院时间延长 21.41（95%CI，10.81-32.02）、呼吸机使用时间延长 10.80（95%CI，3.63-17.98）和 TPN 使用时间延长 16.21（95%CI，6.34-26.10）有关。
在这项接受手术治疗的 NEC 婴儿的队列研究中，术后非美沙酮类阿片类药物使用时间延长与美沙酮治疗的可能性增加以及术后住院时间、通气和 TPN 使用时间延长有关。优化需要手术的婴儿的术后疼痛管理可能会减少对美沙酮治疗的需求并改善医疗保健的使用。
