Pain management guidelines reduce opioids in post-operative and mechanically ventilated neonates
Bibliographic record
Abstract
ABSTRACT: This study assessed the implementation of pain management guidelines to reduce cumulative opioid exposure by 20% in ventilated and postoperative neonates. We retrospectively analyzed the cumulative opioid exposure dose (expressed in morphine equivalents) in neonates admitted to our intensive care unit who underwent surgery and/or were invasively ventilated for greater than 24 hours, comparing data from 18 months pre-implementation and 16 months postimplementation of pain guidelines. A 3-month transition period was included for implementation. The analysis included demographics, Neonatal Pain, Agitation, and Sedation Scale (NPASS) scores, and safety metrics extracted from the hospitals' electronic health records. Our study cohort included 170 patients (N = 84 preguideline, N = 11 transition period, N = 75 postguideline). Gestational age and days of life at admission, sex, and birth weight were similar between study periods. Cumulative median opioid exposure (mg/kg) was reduced by 55% with guideline implementation: median ([interquartile range], preguideline 4.5 [1.3-11.4], postguideline 2.0 [0.6-0.55], P = 0.009; difference of medians [95% bootstrap confidence interval] 2.5 [0.17-4.88]). Length of stay (days) was similar (preguideline 11 [7-26], postguideline 9 [4.5-18.5], P = 0.3). The frequency of NPASS measurement increased significantly (preguideline 21%, postguideline 65%, P < 0.001). Median NPASS pain/agitation and sedation scores were unchanged during the study. There was no increase preguideline and postguideline in mortality (18%, 12%, P = 0.6), rates of intubation (85%, 75%, P = 0.12), median duration of peripheral intravenous access (4 [2-6], 4 [2-6] days, P = 0.4), or median duration of total-parenteral nutrition (7 [3-14] days, 7.5 [4-16] days, P = 0.8). Evidence-based guidelines reduced cumulative opioid exposure in mechanically ventilated and postoperative neonates by 55% without adverse effects on pain and increased documentation of pain assessments by 44%.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.019 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".