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Show A Clinical Practice Guideline for the Recognition, Diagnosis and Management of Neonatal Delirium Krista Schulte, RN, BSN; Lisa Giles, MD; Pamela Phares, PhD, APRN, CNM Key findings: Delirium in the neonatal ICU is under-diagnosed and undertreated. A CPG to inform NICU practice regarding the management of neonatal delirium was created. Educational sessions for stakeholders regarding neonatal delirium and presentation of the clinical practice guideline increased awareness, understanding and confidence in the recognition, diagnosis and management of neonatal delirium. Background Results Delirium is an acute and fluctuating change in awareness and cognition that is under-diagnosed and undertreated. Its prevalence in in children < age 2 years is approximately 20% (Traube et al., 2017). A total of 37 participants (37%) completed a pre- and posttest. A paired t-test was used to measure the change between pretest and posttest scores to assess knowledge. The level of significance was set at p ≤ 0.5. Qualitative responses were evaluated for content and summarized. Delirium can lead to prolonged mechanical ventilation, lengthened hospital stay and increased morbidity and mortality (Groves et al., 2016). Risk factors for neonatal delirium include age < 2 yo, severity of illness, post-op recovery, treatment with benzodiazepines, opioids and anticholinergics, restraints, withdrawal and mechanical ventilation (Traube et al., 2017). Environmental interventions such as promoting uninterrupted sleep, providing appropriate developmental stimulation, and treating pain may help prevent and treat delirium. In some refractory cases pharmacologic management may be necessary (Turkel et al., 2013) Methods Setting: 52 bed level 4 newborn ICU of a large tertiary care facility. Participants: 12 neonatologists, 6 neonatal fellows, 14 NNPs, 2 child psychiatrists, and 1 MD and 2 NNPs from the palliative care team. A clinical practice guideline (CPG) for delirium management was developed for infants > 37 weeks corrected gestational age up to 24 months of age based on the most current evidence. Education on delirium and presentation of the CPG to key stakeholders were provided. Pre- and post-education questionnaires were administered to participants to determine whether learning occurred. Feedback from participants regarding the CPG was also collected. https://www.picwallz.com/cute-newborn-baby-boy-pictures/widescreen-cute-newborn-baby-boy-smiling-loving-with-pictures-hd-of-laptop/ The educational presentation increased knowledge and confidence in recognizing signs/symptoms of delirium (p=0.0001), understanding high-risk factors (p=.0001), using CAPD screening tool to aid in diagnosis (p=.0001), understanding what environmental measures help prevent and treat delirium (p=.0001) and using pharmacologic management (p=.0001). Participant feedback was obtained during educational sessions and incorporated into the final CPG draft. Conclusions The education provided to key stakeholders was effective in increasing awareness, understanding, and confidence in the recognition, diagnosis and management of neonatal delirium. Key stakeholders provided meaningful feedback that was incorporated into the final CPG draft which will be submitted for institutional approval May 2018. Future studies will need to be conducted to assess the effectiveness of the CPG after its implementation into the clinical setting. References Groves, A., Traube, C., & Silver, G. (2016). Detection and management of delirium in the neonatal unit: A case series. Pediatrics, 137(3), e1-e4. doi: 10.1542/peds.2015-3369 Traube, C., Silver, G., Reeder, R.W., Doyle, H., Hegel, E., Wolfe, H.A., … Bell, M.J. (2017). Delirium in critically ill children: An international point prevalence study. Critical Care Medicine, 45(4), 584-590. doi: 10.1097/CCM.0000000000002250 Turkel, S.B., Jacobson, J.R., & Tavaré, C.J. (2013). The diagnosis and management of delirium in infancy. Journal of Child and Adolescent Psychopharmcology, 23(5), 352–356. doi: 10.1089/cap.2013.0001 COLLEGE OF NURSING |
