722 - Analysis of Iatrogenic Withdrawal Syndrome in the Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort Study

Poster Number: 722
Publication Number: 722.401

Jennifer J. Lee, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Ann Kim, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Caleb Ing, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Lena Sun, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Children in the pediatric intensive care unit (PICU) often require prolonged sedation to maintain mechanical ventilation (MV) and other life-sustaining therapies. Opioids and benzodiazepines are the most commonly used drugs for sedation. The cessation or weaning after lengthy administration of these agents may precipitate iatrogenic withdrawal syndrome (IWS), which has been associated with acute multi-organ disturbances, prolonged PICU/hospitalization stays, and serious long-term neurologic sequelae.

Objective: To characterize IWS occurrence in MV PICU patients at New York Presbyterian Morgan Stanley Children's Hospital (MSCH) from 2015 to 2019, describe trends of sedative administration, and determine whether IWS is associated with increased in-hospital mortality.

Design/Methods: With IRB approval, a retrospective analysis was performed using the Pediatric Health Information System Database. IWS cases were identified by ICD diagnosis codes for sedative/opioid dependence or withdrawal, and administration of methadone, lorazepam, or clonidine. Demographic and clinical data were reported as median ± IQR. IWS and non-IWS patients were compared using chi-squared/Mann-Whitney U tests. Multiple logistic regression was used to identify factors independently associated with in-hospital mortality.

Results: Of 4,829 discharges, there were 3,686 total patients. IWS frequency was 33.0% (n=1,216) with a decline from 36.8% (n=262) in 2015 to 27.6% (n=231) in 2019. IWS patients (3.0 ± 12.0 years) were older than non-IWS (1.0 ± 8.0 years) and more likely to be publicly insured (57.4%, n=698) than non-IWS (52.2%, n=1,289). IWS patients also had more comorbidities and longer hospitalization stays (Table 1). Fentanyl was administered to 66.4% (n=2,446) of all patients followed by dexmedetomidine (60.8%, n=2,240), midazolam (57.9%, n=2,133), propofol (50.1%, n=1,847), morphine (47.2%, n=1,740), hydromorphone (16.4%, n=605), and ketamine (15.7%, n=579) (Figure 1). 41.0% (n=1,511) received neuromuscular blockade (NMB). IWS patients received more sedative drugs and NMB than non-IWS. IWS was associated with higher in-hospital mortality (OR=2.44; 95% CI 1.76-3.39, p< .001).

Conclusion(s): IWS occurred in about one-third of MV PICU patients in this single-center retrospective cohort study. IWS was associated with significantly higher in-hospital mortality adjusting for covariates. IWS patients had more comorbidities, lengthier hospitalization, and more frequently received sedative drugs and NMB than non-IWS. Further analyses are needed to elucidate factors contributing to higher in-hospital mortality observed with IWS.