There has been a rapid increase in the rate of pediatric opioid-related hospitalizations. It is unknown how this increase has impacted the use of pediatric critical care. Our objective in this study was to assess the trends in pediatric hospitalization for opioid ingestions in a cohort of US children’s hospitals and, specifically, to evaluate the impact on pediatric critical care resource use.
A retrospective cohort study of the Pediatric Health Information System was performed to identify hospitalizations for opioid ingestions from 2004 to 2015. Admission to the PICU and the use of naloxone, vasopressors, and ventilation were assessed by using billing data. The primary outcome measure was the trend in the rate of PICU admission for opioid-related ingestion over time, assessed by using Poisson regression.
There were 3647 opioid-related hospitalizations in 31 hospitals; 42.9% required PICU care. The overall mortality was 1.6%, with annual deaths decreasing from 2.8% to 1.3% (P < .001). The number of opioid-related hospitalizations requiring PICU care doubled between 2004 and 2015. The rate of PICU admission for opioid-related hospitalization increased significantly, from 24.9 to 35.9 per 10 000 PICU admissions (P < .001). Among PICU admissions, 37.0% required mechanical ventilator support, and 20.3% required vasopressors.
The US opioid crisis is negatively impacting children, and the rate of hospitalization and PICU admission for pediatric opioid ingestions is increasing. Current efforts to reduce adult opioid use have not curtailed the incidence of pediatric opioid ingestions, and additional efforts are needed to reduce preventable opioid exposure in children.
Comments
RE: Children on Opioids?
Children on Opioids?
The article titled Opioid-related critical care resource use in us children’s hospitals1 fascinated me from both a personal and professional perspective. I am intrigued by the many
factors that can influence the growth and development of our children. There is an opioid
epidemic that is impacting pediatric patients in the United States. Overall, the article discusses
the worrisome increase in the incidence of prescription opioid-related hospitalizations for
ingestions and poisonings among children. “A retrospective cohort study of the Pediatric Health
Information System was performed to identify hospitalizations for opioid ingestions from 2004
to 2015.”1 Pediatric admissions for opioid ingestions have increased by 35%. The article provides extensive data from 49 hospitals located in 27 states across the United States that show the dramatic increase. The main question we need to ask ourselves in today’s day and age is, “Why are children overdosing on prescription opioids?”
Opioid ingestion among children can occur a few different ways; a child may accidently
ingest a prescription due to lack of parental and/or caretaker supervision or the developing fetus
may be exposed to opioids as per the passing of the opioid from mother to child in the womb.
There is a rising incidence of neonatal abstinence syndrome due to opioid use and misuse during
pregnancy.2 There should be a mandatory screening process for all variations of substance use, and such should be an ongoing part of all comprehensive obstetric exams throughout the entire pregnancy. There may be a specific reason for opioid use during pregnancy in the context of prescribed medical care however, the care of the unborn needs to be a top medical priority.3 As such, physicians need to educate all “mothers to be” regarding the dangers of taking opioids during pregnancy. Our children are our future, and each and every child deserves to begin their lives drug free.
References
Kane JM, Colvin JD, Bartlett AH, et al. Opioid-Related Critical Care Resource Use in US Children’s Hospitals. Pediatrics. 2018;141(4):e20173335
2. National Institute on Drug Abuse. Opioid overdose crisis. Available at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Accessed April 11, 2018
3. The American College of Obstetricians and Gynecologists. ACOG committee opinion. Available at https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinio.... Accessed April 11, 2018