Variation in opioid utilization among neonates with gastroschisis

• Published in: Journal of pediatric surgery 2021-07, Vol.56 (7), p.1113-1116
• Main Authors: Li, Linda T., Hebballi, Nutan B., Reynolds, Eric W., Arshad, Seyed A., Hatton, Gabrielle E., Ferguson, Dalya M., Austin, Mary T., Lally, Kevin P., Tsao, Kuojen
• Format: Article
• Language: English
• Subjects: Gastroschisis; Narcotics; Neonatology; Opioids; Pain management; Variability
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2021.03.030

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 III