Factors Associated with Wean Duration Length as a Measure of Iatrogenic Withdrawal Syndrome in the Neonatal Intensive Care Unit: A Retrospective Chart Review

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.

Department dc:contributor.department

Nursing

Year dc:date.issued

2024

Author dc:creator

• Joseph, Marianne Nirosha

Advisor dc:contributor.supervisor

• Mahar, Alyson

• Neonate
• Iatrogenic Withdrawal Syndrome
• Wean Duration
• Opioids
• Benzodiazepines

Statement dc:rights

• Attribution 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by/4.0/

Language dc:language.iso

eng

Handle dc:identifier.uri

https://hdl.handle.net/1974/33558

OAI identifier oai:identifier

oai:queensu.scholaris.ca:1974/33558