Opioid exposure in neonates and infants following cardiac surgery: a comparative analysis

Abstract Introduction: Both untreated pain and opioid exposure impact neurodevelopment in critically ill infants. Mitigating both remains a challenge in the management of infants undergoing cardiac surgery. Our aim was to describe and compare opioid exposure in neonates (≤ 30 days of age), and infants’ (>30 days of age) post-cardiac surgery Methods: We conducted a secondary analysis of a single center retrospective cohort of all CICU surgical patients < 1 year of age to quantify opioid exposure within 5 days post-surgery. Patient demographics, surgical data, pain medications and pain/sedation scores were collected and analyzed. Results: Of 170 patients less than 1 year of age, 75 were neonates at time of surgery. Groups were similar with respect to gender, race, ethnicity and genetic abnormalities. Biventricular CHD without arch obstruction was more common in infants. Neonates had significantly longer duration of mechanical ventilation, ICU and hospital length of stay. Mean total opioid exposure was significantly higher in neonates (10.39 ± 8.85mgMME/kg/5days) than in infants (5.06 ± 10.01mgMME/kg/5days) (p < 0.001). Initial and maximum opioid infusion doses were higher in neonates than infants (0.93 vs 0.74 mgMME/kg/hr; 1.32 vs. 1.13 mgMME/kg/hr), as were as needed (PRN) doses (22 vs.13). Dexmedetomidine exposure was greater in neonates (45.39 ± 39.09 vs. 29.01 ± 33.50 mcg/kg/5d), and more neonates were discharged on Methadone (31.3% vs. 10.8%). Discussion: Compared to infants, neonates with CHD had more complex disease and postoperative opioid exposure. Higher opioid exposure in neonates, compared to infants underscores the heightened vulnerability of neonates who requires surgery compared to the infant >30 days. These findings also suggest the need for careful pain assessment and additional strategies to address pain in this vulnerable population.