(71 - Friday) Beyond Pain Management: An Interdisciplinary and Developmentally Centered Approach to Optimize Comfort in Neonates Following Cardiac Surgery

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Abstract:

Introduction:
Developmental care has become standard practice to optimize neurodevelopment. However, neonates after cardiac surgery face unique challenges, including painful procedures, immobility, parental separation, lines, tubes, wires, and many more. Recognizing the effects of undertreated pain and opioid exposure on brain development, we developed a “Comfort Curriculum” (CC) that included pharmacological and non-pharmacological methods of pain control for post-operative cardiac surgery patients. The aim of this study was to determine if the implementation of a CC could reduce opioid exposure without increasing pain scores.

Methods:
The CC was developed by an interdisciplinary team and consists of a pain management pathway, non-pharmacologic support table and infant holding guidelines. We assessed patient demographics, type of congenital heart disease surgical procedure, pain scores, opioid dosing, and other postoperative variables in neonates undergoing cardiac surgery pre- and post-CC implementation. Outcomes in neonates were compared using Wilcoxon rank sum tests for continuous variables and chi2 tests for categorical variables.

Results:
The pre-CC group (n=36) weighed significantly more than the post-CC group (n=39) (3.03 ± 0.85 vs 3.35 ± 0.71 kg; p=0.037) but was otherwise similar with respect to gestational age, age at surgery, gender, race, ethnicity, and diagnosis class. Despite similar pain scores between the groups, the post-CC had significantly lower initial opioid doses in morphine equivalents (ME) [1.16 ± 0.33 mgME/kg pre-implementation to 0.77 ± 0.25 mgME/kg post-implementation, (p < 0.001] and maximum opioid doses [1.54 ± 0.52 mgME/kg pre-implementation to 1.16 ± 0.51 mgME/kg post-implementation, (p = 0.008]).

Discussion:
The results of this study support that an interdisciplinary, developmentally centered approach to comfort care following cardiac surgery can significantly reduce opioid exposure without increasing pain scores in neonates. Effective implementation of the CC required a strong commitment by a dedicated interdisciplinary team and a willingness to adopt non-pharmacological measures to optimize comfort. This study may serve as baseline data for a multicenter trial to assess generalizability. Likewise, it may help support future studies on reduced opioid exposure and developmental outcomes of neonatal cardiac surgical patients.