RESUMO
OBJECTIVE: To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines. STUDY DESIGN: Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014). RESULTS: Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods. Number of patients exposed to opioids decreased from 62.9% (129/205) in period 1 to 32.8% (82/250) in period 2, P=<0.001. Cumulative dose exposure decreased, opioids in morphine equivalent dose, mg kg-1 (1.64 (0.38 to 6.94) vs 0.51 (0.04 to 2.33), P=0.002), sedatives in midazolam equivalent, mg kg-1 (0.16 (0.03 to 7.39) vs 0.10 (0.00 to 4.00), P=0.03). Ten patients required treatment for iatrogenic opioid withdrawal versus only three in post guideline, P=0.02. CONCLUSIONS: Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.
Assuntos
Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Manejo da Dor/métodos , Guias de Prática Clínica como Assunto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Medição da Dor/métodos , Respiração Artificial , Insuficiência Respiratória/terapia , Estudos RetrospectivosRESUMO
OBJECTIVE: To compare feeding tolerance, nutrient intake and growth in preterm infants (< or =32 weeks, < or =1750 g) fed either a standard nonhydrolyzed whey-casein (nHWC) or a partially hydrolyzed whey (pHW) preterm infant formula. STUDY DESIGN: In this double-blind randomized controlled trial infants were fed either formula for at least 3 weeks. Intake was monitored daily, serum chemistries and growth weekly. Data were analyzed using analysis of covariance. RESULT: A total of 80 infants were enrolled, 72 completed the study. No differences were noted in demographic characteristics. No differences were detected in feeding tolerance, intakes (118+/-21 vs 119+/-14; nHWC vs pHW) or growth weight, 28+/-1.5 vs 28+/-1.6 g per day; length, 1.0+/-0.7 vs 1.0+/-0.6 cm per week; head circumference, 0.9+/-0.4 vs 1.0+/-0.44 cm per week). At the end of study, blood urea nitrogen (5.2+/-3.1 <6.7+/-2.3 mg per 100 ml, nHWC