4CPS-265 Chronic complex palliative paediatric patient at-home care unit: pharmacotherapeutic profile and analysis of sialorrhea treatment

• Published in: European journal of hospital pharmacy. Science and practice 2022-03, Vol.29 (Suppl 1), p.A198-A198
• Main Authors: Rovira, T, de Castro Julve, M, Gili Bigatà, T, Gómez Llanes, G, Campos García, Y, Molas Ferrer, G, López García, B, Gómez-Valent, M
• Format: Article
• Language: English
• Subjects: Conflicts of interest; Constipation; Drug therapy; Patients; Pediatrics; Section 7: Post Congress additions; Spasticity; Speech therapy
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2022-eahp.415

Background and importanceAnalysing the patients’ characteristics in one paediatric palliative care unit is significant, as there are few such units in our hospitals. Sialorrhoea is one of the commonly associated symptoms in these patients and its treatment frequently presents a challenge for healthcare professionals.Aim and objectivesTo describe characteristics of patients followed in a Chronic Complex Palliative Paediatric Patient at-Home Care Unit (CCPPHCU) of a university hospital.To analyse the treatment of sialorrhoea.Material and methodsObservational, retrospective and transversal study included patients in the CCPPHCU during April 2021. Data were collected from the electronic medical history. Sociodemographic, clinical and pharmacotherapeutic variables were registered.Patients with sialorrhoea were registered if they needed pharmacological treatment and/or surgery. Data collection included the number of drugs and the treatment with trihexyphenidyl, scopolamine, glycopyrrolate and botulinic toxin.A descriptive analysis was performed.ResultsThirty-six patients were included, with a mean age of 9.5 (±5.5) months (7 months–19 years) years and 20 (55.6%) of them were males.A rare illness was the main diagnostic in 33.3%. Mean time in the CCPPHCU until analysis: 22.5 months (±14.5) (10 days–4.1 years). 80.6% of patients developed convulsions, 66.7% constipation, 58.3% sialorrhoea and 55.6% spasticity.Mean number of drugs was 6.9 (±3.9) (1–16). 50% of the patients underwent speech therapy. 66.7% took laxatives, 66.7% anticonvulsants and 25% antispasmodics. At least one magistral preparation was prescribed in 16.7%.Amongst patients with sialorrhoea, 81% required drug treatment and 19% only speech therapy. 52.4% were treated with 1 drug, 9.5% with 2, and 19% with ≥3 drugs. 71.4% took trihexyphenidyl at some point, 33.3% scopolamine, 19% glycopyrrolate and 4.8% botulinum toxin. Among patients receiving drug treatment, the first-line was trihexyphenidyl in 82.4%, scopolamine in 11.8% and glycopyrrolate as a magistral formula in 5.9%. Of those treated with >1 drug, 83.3% used scopolamine as a second-line. None underwent surgery to prevent hypersalivation.Conclusion and relevanceSeizures, constipation, sialorrhoea, and spasticity are common symptoms in patients in our CCPPHCU, often requiring medication.In the case of patients with sialorrhoea, the majority required pharmacological treatment, with trihexyphenidyl being the most used as first-line, followed by sc