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Opioid exposure during therapeutic hypothermia and short-term outcomes in neonatal encephalopathy

Journal of Perinatology volume 42, pages 1017–1025 (2022)Cite this article

Subjects

Abstract

Objective

To assess the association between opioid exposure during therapeutic hypothermia (TH) for perinatal hypoxic-ischemic encephalopathy (HIE) and in-hospital outcomes.

Study design

In this retrospective cohort study, linked data were accessed on infants ≥36 weeks gestation, who underwent TH for HIE, born from 2010–2016 in 23 Neonatal Intensive Care Units participating in Children’s Hospitals Neonatal Consortium and Pediatric Health Information Systems. We excluded infants who received opioids for >5 days.

Results

The cohort (n = 1484) was categorized as No opioid [240(16.2%)], Low opioid (1–2 days) [574 (38.7%)] and High opioid group (HOG, 3–5 days) [670 (45.2%)]. After adjusting for HIE severity, opioids were not associated with abnormal MRI, but were associated with decreased likelihood of complete oral feeds at discharge. HOG had increased likelihood of prolonged hospital stay and ventilation.

Conclusion

Opioid exposure during TH was not associated with abnormal MRI; its association with adverse short-term outcomes suggests need for cautious empiric use.

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Fig. 1: Intercenter variation in opioid cost during TH, with 3 centers showing statistically significant differences in OR and 95% C.I.

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Data availability

The data that support the findings of this study are available from Childrens’ Hospitals Neonatal Database, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.

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Author information

Authors and Affiliations

  1. Pediatrics, Central Michigan University, Children’s Hospital of Michigan, Detroit, MI, USA

    Girija Natarajan

  2. Pediatrics, Emory University, Atlanta, GA, USA

    Shannon E. Hamrick

  3. Children’s Hospital Association, Lenexa, KS, USA

    Isabella Zaniletti

  4. Pediatrics, Hospital for Sick Children, Toronto, ON, Canada

    Kyong-Soon Lee

  5. Pediatrics/Neonatology, Seattle Children’s Hospital/University of Washington, Seattle, WA, USA

    Ulrike Mietzsch & Robert DiGeronimo

  6. Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Maria L. V. Dizon

  7. Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA

    Eric S. Peeples

  8. Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Toby D. Yanowitz

  9. Neonatology, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Tai-Wei Wu

  10. Pediatrics/ Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    John Flibotte

  11. Neonatology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, USA

    Priscilla Joe

  12. Neonatology, Children’s National Health Systems, Washington, DC, USA

    An N. Massaro

  13. Pediatrics, Washington University in St. Louis, St. Louis, MO, USA

    Rakesh Rao

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  1. Girija Natarajan
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Consortia

Children’s Hospitals Neonatal Database Hypoxic-Ischemic Encephalopathy Focus group

Contributions

All authors contributed sufficiently to the intellectual content of the submission. GN had the final responsibility for the decision to submit for publication. SHE, KSL, UM, RDG, MLVD, ESP, TDY, TWW, JF, PJ, ANM, RR were all involved in reviewing study design, all acquired data from their sites, and played an important role in interpreting the results, revising the manuscript, approving the final version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GN, ANM, RR conceived and designed the work and drafted the initial manuscript. IZ was responsible for data review and validation, linking of databases and all data analysis.

Corresponding author

Correspondence to Girija Natarajan.

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Competing interests

Author IZ is an employee of Children’s Hospitals Association, Kansas City, MO. Other authors declare no competing interests.

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Natarajan, G., Hamrick, S.E., Zaniletti, I. et al. Opioid exposure during therapeutic hypothermia and short-term outcomes in neonatal encephalopathy. J Perinatol 42, 1017–1025 (2022). https://doi.org/10.1038/s41372-022-01400-x

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