Factors Associated with Wean Duration Length as a Measure of Iatrogenic Withdrawal Syndrome in the Neonatal Intensive Care Unit: A Retrospective Chart Review
Notice bibliographique
Résumé
Background: Neonates admitted to the Neonatal Intensive Care Unit (NICU) receive opioids and benzodiazepines for reasons including surgical procedures and mechanical ventilation. Neonates who are exposed to high doses of opioids and benzodiazepines for prolonged periods of time, are at an increased risk of iatrogenic withdrawal syndrome (IWS). There is currently little research to document which patient, process, or system factors are associated with longer wean duration to guide clinical and policy decision-making. Methods: A cross-sectional study was performed using data collected through a chart review of NICU admissions at the Children’s Hospital of Eastern Ontario between January 1, 2019 and December 31, 2022. Univariate and multivariable linear regressions were used to estimate associations between patient, process, and system level variables and wean duration length. Results: Patient, process, and system level variables were associated with wean duration length on univariate analysis. Neonates with younger gestational age, lower birth weight, an immune-related admission problem, intubated for longer durations or greater frequency, experienced longer wean duration. Receipt of hydromorphone, midazolam, lorazepam, and ketamine were associated with longer wean duration, as was receiving more than one medication. Larger cumulative doses of hydromorphone, lorazepam, clonidine, methotrimeprazine, and gabapentin were also associated with longer wean duration. Documentation of ethnicity was associated with longer wean duration. In the multiple regression model that included gestational age at birth, birth weight, sex, and whether ethnicity was reported, documentation of ethnicity was associated with longer wean duration. In the multiple regression model that included type of surgery intubation occurrences and sepsis, a greater number of intubations and being tested for sepsis were associated with longer wean duration. In the multiple regression model that included the type of medications administered, receipt of hydromorphone, lorazepam, and ketamine were associated with longer wean durations. Conclusions: This was the first study of its kind in a Canadian NICU to examine the association between wean duration and key covariates to inform the reduction of IWS. This study provided exploratory evidence of patient-, process-, and system-level factors associated with wean duration among neonates receiving opioids and/or benzodiazepines which can be further validated through future studies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,003 | 0,005 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».