IV acetaminophen with opioids in EA/TEF repair has advantages and disadvantages
"I’m all for reducing opioids, especially in neonates, for whom we are unsure of long-term adverse effects," stated Jon Matthew Farber, MD.
IV acetaminophen with opioids in EA/TEF repair has advantages and disadvantages | Image credit: Contemporary Pediatrics
Analysis of data for infants who underwent esophageal atresia and tracheoesophageal fistula (EA/TEF) repair suggest that the use of intravenous (IV) acetaminophen along with opioids (IV APAP) instead of opioids alone is associated with a longer length of stay (LOS) but decreased daily costs and mortality.
This finding was based on analysis of data for 1101 neonates who underwent EA/TEF repair in 47 US children’s hospitals and were given opioids or opioids and IV APAP during their hospitalizations.
Of the total study group, 537 received only opioids and 564 received both opioids and IV APAP. Patients’ age ranged from 0 to 28 days, and 90.3% of patients were diagnosed with EA/TEF.
The opioids and IV APAP group had a median LOS of 47.5 days compared with 32 days for the opioids-only group. In addition, the group receiving opioids and IV APAP had a mean 58.7 days on total parenteral nutrition compared with 24.4 days in the opioids-only group.
The opioids and IV APAP group had significantly better mortality rates than those in the opioids-only group: 4.1% vs 15.1%, respectively. Despite a longer LOS, infants in the opioids and IV APAP group had lower mean daily costs, but the 2 groups did not differ significantly in pharmacy and total costs.
THOUGHTS FROM DR FARBER
I’m all for reducing opioids, especially in neonates, for whom we are unsure of long-term adverse effects, such as whether administration of opioids increases the risk of addiction in adulthood. Reduced mortality is an obvious plus, but a 2-week longer hospital stay has its own drawbacks. We have to hope that a future study will provide more definitive results.
Reference:
Phillipi MA, Song AY, Yieh L, Gong CL. Costs and outcomes associated with the administration of intravenous acetaminophen in neonates after esophageal atresia and tracheoesophageal fistula repair. Pediatr Neonatol. Published online July 6, 2024. doi:10.1016/j.pedneo.2024.02.010
