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Effects of an IV acetaminophen-based pain protocol on neonatal post-operative outcomes
Christopher Zaro*, Symren Dhaliwal, Muriel Cleary

Medical School, University of Massachusetts Chan Medical School, Worcester, MA

Objective: In January 2020 an institutional policy change allowed for use of IV acetaminophen in post op NICU patients without pharmacy approval. We sought to evaluate if patients receiving IV acetaminophen in addition to opioids had earlier time to extubation, full feeding, and discharge.

Design: We conducted a retrospective chart review of post-op NICU patients from January 2018 to 2022. Data extracted from EMR included basic demographics, surgery type, time to extubation, time to full feeds, length of stay, highest NPASS score in first 24 hours and dosing of acetaminophen and fentanyl.

Setting: This study was conducted at a tertiary care setting with a pediatric surgery department.

Interventions: We investigated previous interventions of fentanyl, acetaminophen, or both during the seven-day post-operative period.

Main Outcome Measures: Our primary outcomes were assessing the time to extubation, the time to full feeding, length of stay, and highest NPASS score for patients receiving IV or PO acetaminophen, fentanyl, or both.

Results: We identified 146 NICU surgical patients who either received IV/PO acetaminophen, fentanyl, or both during their 7-day postoperative period. After excluding PO acetaminophen alone, further stratification was performed into "large" (N=70) and "small" (N=20) cases. Patients receiving IV acetaminophen and fentanyl compared to fentanyl alone had decreased time to extubation, with no significant difference in time to full feeds or length of stay. When stratified by surgical type (large vs small), time to extubation and time to full feeds were both significantly decreased for patients undergoing large surgeries who received the combination of IV acetaminophen and fentanyl [Chart 1]. There was no significant difference in NPASS score.

This study concluded that patients who received IV acetaminophen and fentanyl had significantly lower time to extubation when compared to fentanyl alone and that this effect extended to a significant decrease in time to full feeds for those patients undergoing larger operations. These findings suggest that the augmented effect of IV acetaminophen for pain management can lead to fewer risks associated with narcotic usage in the post-operative period.

Comparing Postoperative Outcomes for IV Acetaminophen and Fentanyl in NICU patients
 IV Acetaminophen and fentanyl
Fentanyl (n=18)P-Value
Average length of stay (days)69950.13
Large Cases Length of Stay671080.09
Small Cases Length of Stay761000.36
Median Time to Extubation271600.01
Large Cases Time to Extubation272790.02
Small Cases Time to Extubation7.734.70.15
Median Days to Full Feeds15.2390.06
Large Cases Days to Full Feeds16400.08
Small Cases Days to Full Feeds031<0.0001

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