Factors Associated with Wean Duration Length as a Measure of Iatrogenic Withdrawal Syndrome in the Neonatal Intensive Care Unit: A Retrospective Chart Review
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Authors
Joseph, Marianne Nirosha
Date
2024-10-09
Type
thesis
Language
eng
Keyword
Neonate , Iatrogenic Withdrawal Syndrome , Wean Duration , Opioids , Benzodiazepines
Alternative Title
Abstract
Background: Neonates admitted to the Neonatal Intensive Care Unit (NICU) receive
opioids and benzodiazepines for reasons including surgical procedures and mechanical ventilation. Neonates who are exposed to high doses of opioids and benzodiazepines for prolonged periods of time, are at an increased risk of iatrogenic withdrawal syndrome (IWS). There is currently little research to document which patient, process, or system factors are associated with longer wean duration to guide clinical and policy decision-making.
Methods: A cross-sectional study was performed using data collected through a chart review of NICU admissions at the Children’s Hospital of Eastern Ontario between January 1, 2019 and December 31, 2022. Univariate and multivariable linear regressions were used to estimate associations between patient, process, and system level variables and wean duration length.
Results: Patient, process, and system level variables were associated with wean duration length on univariate analysis. Neonates with younger gestational age, lower birth weight, an immune-related admission problem, intubated for longer durations or greater frequency, experienced longer wean duration. Receipt of hydromorphone, midazolam, lorazepam, and ketamine were associated with longer wean duration, as was receiving more than one medication. Larger cumulative doses of hydromorphone, lorazepam, clonidine, methotrimeprazine, and gabapentin were also associated with longer wean duration. Documentation of ethnicity was associated with longer wean duration. In the multiple regression model that included gestational age at birth, birth weight, sex, and whether ethnicity was reported, documentation of ethnicity was associated with longer wean duration. In the multiple regression model that included type of surgery intubation occurrences and sepsis, a greater number of intubations and being tested for sepsis were associated with longer wean duration. In the multiple regression model that included the type of medications administered, receipt of hydromorphone, lorazepam, and ketamine were associated with longer wean durations.
Conclusions: This was the first study of its kind in a Canadian NICU to examine the association between wean duration and key covariates to inform the reduction of IWS. This study provided exploratory evidence of patient-, process-, and system-level factors associated with wean duration among neonates receiving opioids and/or benzodiazepines which can be further validated through future studies.
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution 4.0 International