| Description |
Gastroschisis is an abdominal wall defect specific to the neonatal population, where the abdominal organs protrude through an opening next to the umbilicus. The severity of the defect varies between patients, but all infants with the diagnosis of gastroschisis will require surgical intervention. Pain management is a key component of well-rounded care, and there is evidence that ineffective pain management may ultimately lead to poor neurodevelopmental outcomes. However, many medications used for pain control may have long-term adverse effects, as well as affecting other aspects of care, such as the requirement of mechanical ventilation, prolonging the time to initiating and achieving full enteral feedings, and increasing length of stay. A Level IV NICU in a children's hospital in Salt Lake City, UT treats many infants born within the state of Utah, and surrounding states, with the diagnosis of gastroschisis. Currently there are no standardized pain management guidelines within the NICU, so prescribing practices may vary greatly between providers. The purpose of this scholarly project is to collect data and assess what the current prescribing practices of analgesic medications are. The objectives for this project include: (1) performing a retrospective review of approximately a 2-year period to determine the usage of analgesic medications in patients with a diagnosis of gastroschisis in the Level IV NICU, (2) determining methods of analgesic medication administration including medication used and dosing, and comparing them with variables including gestational age, birth weight, post-operative days, severity of defect, method of defect closure, days to feeding initiation, days to full enteral feedings, ventilator days, and length of stay, (3) comparing data collected from chart reviews with information obtained in the literature review, (4) presentation of information obtained in the project to providers in the NICU, and submission of an abstract to a neonatal conference for dissemination to a broader audience. Approval from the Internal Review Boards (IRB) within the institutions was obtained and data were collected through a review of medical records of patients who met the specified criteria using a data collection tool created for this project. The data were analyzed using descriptive statistics, and a report was generated to illustrate the information obtained. The data obtained in the chart reviews were compared with information obtained in the literature review, and will be presented to care providers in the NICU. An abstract was also prepared for submission to a neonatal conference for dissemination to a wider audience. 44 patients met the established criteria for inclusion. Infants were born at 34 weeks gestation or greater and had a mean birth weight of 2.5 kg with a range of 1.6-3.5 kg, a mean LOS of 32 days with a range of 13-90 days; 55% were male, 45% were female. Medications received included morphine, fentanyl, and acetaminophen, with 61% receiving a combination of an opioid and acetaminophen. 80% received bolus doses, and 20% received continuous infusions. Infants who received continuous opioid infusions received more medication than those who received boluses only. Infants who received acetaminophen in addition to an opioid medication received less narcotic medication than those who only received opioids. Between January 2012 and October 2014 Fentanyl usage decreased, morphine was variable, and acetaminophen use increased. Infants who received higher average total doses of fentanyl started feedings earlier than those who received higher average total morphine doses, but infants who received higher fentanyl doses took longer to achieve full feedings than infants with increased morphine doses. |
