VARIATION AMONG NEONATAL INTENSIVE-CARE UNITS IN NARCOTIC ADMINISTRATION

Objectives: To compare rates of narcotic administration for medically treated neonates in different neonatal intensive care units (NICUs) an d to compare treated and untreated neonates to assess whether narcotic s provided advantages or disadvantages for short-term outcomes, such a s cardiovascular stability tie, blood pressure and heart rate), hyperb ilirubinemia, duration of respiratory support, growth, and the inciden ce of intraventricular hemorrhage. Study Design: The medical charts of neonates weighing less than 1500 g, admitted to 6 NICUs (A-F), were a bstracted. Neonates who had a chest tube or who had undergone surgery were excluded from the study, leaving the records of 1171 neonates. We modeled outcomes by linear or logistic regression, controlling for bi rth weight (<750, 750-999, and 1000-1499 g) and illness severity (low, 0-9; medium, 10-19; high, greater than or equal to 20) using the Scor e for Neonatal Acute Physiology (SNAP), and adjusted for NICU. Results : Narcotic use varied by birth weight (<750 g, 21%; 750-999 g, 13%; an d 1000-1499 g, 8%), illness severity (low, 9%; medium, 19%; and high, 37%), day (1, 1136; 3, 6%; and 14, 2%), and NICU. We restricted analys es to the 1018 neonates who received mechanical ventilation on day 1. Logistic regression, adjusting for birth weight and SNAP, confirmed a 28.6-fold variation in narcotic administration (odds ratios, 4.1-28.6 vs NICU A). Several short-term outcomes also were associated with narc otic use, including more than 33 g of fluid retention on day 3 and a h igher direct bilirubin level (6.8 pmol/L higher [0.4 mg/dL higher], P = .03). There were no differences in weight gain at 14 and 28 days or mechanical ventilatory support on days 14 and 28. Narcotic use was not associated with differences in worst blood pressure or heart rate or with increased length of hospital stay. Conclusions: Our study found a 28.6-fold variation among NICUs in narcotic administration in very lo w-birth-weight neonates. We were unable to detect any major advantages or disadvantages of narcotic use. We did not assess iatrogenic abstin ence syndrome or long-term outcomes. These results indicate the need f or randomized trials to rationalize these widely differing practices.