Preliminary evaluation of a developmentally centred approach to optimise comfort in neonates following cardiac surgery.

INTRODUCTION

Children with CHD are at risk for neurodevelopmental impairments, and though these are often mild, some children face severe developmental challenges. Both unalleviated pain and exposure to opioids in the neonatal period have detrimental effects on the developing brain.

METHOD: We developed and implemented a Comfort Curriculum including a standardised sedation pathway, bedside non-pharmacologic reference, and holding guidelines. Our primary aim was to assess the effect of the Comfort Curriculum on opioid exposure. The secondary aim was to assess the effect of the Comfort Curriculum on pain scores in neonates in the first 5 days after surgery. A retrospective cohort study of all cardiac surgical patients ≤30 days of age at the time of their first operation was conducted before and at two points after implementation of the Comfort Curriculum (3 months and 15 months).

RESULTS

We found that initial and maximum opioid infusion rates significantly decreased between the pre-implementation and both post-implementation phases, while pain scores did not increase. The total cumulative opioid doses in the first five post-operative days showed a non-statistically significant decrease in both post-implementation phases compared to the pre-implementation phase, and median pain scores showed a trend towards decreasing in both post-implementation phases.

DISCUSSION: After implementation of the Comfort Curriculum, we found a significant decrease in the initial and maximum opioid doses and a signal towards a reduction in total opioid dose in the first 5 days after neonatal cardiac surgery.