Variation in opioid utilization among neonates with gastroschisis

Purpose: 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. Methods: 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. Results: 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. Conclusion: 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 (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study retrospectively reviewed the opioid utilization in 30 neonates with gastroschisis and found significant variations primarily prior to fascial closure. Multivariate regression analysis showed that the type of surgery was associated with opioid use after adjusting for weight, gestational age, and gender, with p = 0.02.