Kanecia O Zimmerman1, Christoph P Hornik1, Lawrence Ku1, Kevin Watt1, Matthew M Laughon2, Margarita Bidegain3, Reese H Clark4, P Brian Smith5. 1. Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 2. Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC. 3. Department of Pediatrics, Duke University School of Medicine, Durham, NC. 4. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL. 5. Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: brian.smith@duke.edu.
Abstract
OBJECTIVE: To describe the administration of sedatives and analgesics at the end of life in a large cohort of infants in North American neonatal intensive care units. STUDY DESIGN: Data on mortality and sedative and analgesic administration were from infants who died from 1997-2012 in 348 neonatal intensive care units managed by the Pediatrix Medical Group. Sedatives and analgesics of interest included opioids (fentanyl, methadone, morphine), benzodiazepines (clonazepam, diazepam, lorazepam, midazolam), central alpha-2 agonists (clonidine, dexmedetomidine), ketamine, and pentobarbital. We used multivariable logistic regression to evaluate the association between administration of these drugs on the day of death and infant demographics and illness severity. RESULTS: We identified 19 726 infants who died. Of these, 6188 (31%) received a sedative or analgesic on the day of death; opioids were most frequently administered, 5366/19 726 (27%). Administration of opioids and benzodiazepines increased during the study period, from 16/283 (6%) for both in 1997 to 523/1465 (36%) and 295/1465 (20%) in 2012, respectively. Increasing gestational age, increasing postnatal age, invasive procedure within 2 days of death, more recent year of death, mechanical ventilation, inotropic support, and antibiotics on the day of death were associated with exposure to sedatives or analgesics. CONCLUSIONS: Administration of sedatives and analgesics increased over time. Infants of older gestational age and those more critically ill were more likely to receive these drugs on the day of death. These findings suggest that drug administration may be driven by severity of illness.
OBJECTIVE: To describe the administration of sedatives and analgesics at the end of life in a large cohort of infants in North American neonatal intensive care units. STUDY DESIGN: Data on mortality and sedative and analgesic administration were from infants who died from 1997-2012 in 348 neonatal intensive care units managed by the Pediatrix Medical Group. Sedatives and analgesics of interest included opioids (fentanyl, methadone, morphine), benzodiazepines (clonazepam, diazepam, lorazepam, midazolam), central alpha-2 agonists (clonidine, dexmedetomidine), ketamine, and pentobarbital. We used multivariable logistic regression to evaluate the association between administration of these drugs on the day of death and infant demographics and illness severity. RESULTS: We identified 19 726 infants who died. Of these, 6188 (31%) received a sedative or analgesic on the day of death; opioids were most frequently administered, 5366/19 726 (27%). Administration of opioids and benzodiazepines increased during the study period, from 16/283 (6%) for both in 1997 to 523/1465 (36%) and 295/1465 (20%) in 2012, respectively. Increasing gestational age, increasing postnatal age, invasive procedure within 2 days of death, more recent year of death, mechanical ventilation, inotropic support, and antibiotics on the day of death were associated with exposure to sedatives or analgesics. CONCLUSIONS: Administration of sedatives and analgesics increased over time. Infants of older gestational age and those more critically ill were more likely to receive these drugs on the day of death. These findings suggest that drug administration may be driven by severity of illness.
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Authors: Christoph P Hornik; Andrew M Atz; Catherine Bendel; Francis Chan; Kevin Downes; Robert Grundmeier; Ben Fogel; Debbie Gipson; Matthew Laughon; Michael Miller; Michael Smith; Chad Livingston; Cindy Kluchar; Anne Heath; Chanda Jarrett; Brian McKerlie; Hetalkumar Patel; Christina Hunter Journal: Appl Clin Inform Date: 2019-05-08 Impact factor: 2.342
Authors: Kanecia O Zimmerman; P Brian Smith; Daniel K Benjamin; Matthew Laughon; Reese Clark; Chani Traube; Til Stürmer; Christoph P Hornik Journal: J Pediatr Date: 2016-08-10 Impact factor: 6.314
Authors: Lawrence C Ku; Kanecia Zimmerman; Daniel K Benjamin; Reese H Clark; Christoph P Hornik; P Brian Smith Journal: Pediatr Cardiol Date: 2016-11-08 Impact factor: 1.838