Delirium in the NICU? Meds to AVOID! A chat with Jen Miller NNP

Some GREAT learning points about how to support a neonate from a neuro-developmental standpoint. How to AVOID and TREAT delirium in the NICU. Delirium in the adult world is a well recognized concept- "A disturbance of consciousness with accompanying change in cognition". The biggest risk factors are length of stay in the ICU and mechanical ventilation.
In this live chat, Jen and I talk about why delirium is relevant in the NICU, how does it present in the NICU population, what are ways to identify delirium (The CAPD scoring system), how to PRVENT delirium and how to TREAT delirium.
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 17 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Adams, S. J., & Sprecher, A. (2022). Delirium in the neonate. Clinics in Perinatology, 49(1), 1–14. https://doi.org/10.1016/j.clp.2021.11.001
Brahmbhatt, K., & Whitgob, E. (2016). Diagnosis and management of delirium in citically ill infants: Case report and review. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-1940
Campbell, C. T., Grey, E., Munoz-Pareja, J., & Manasco, K. B. (2019). An evaluation of risperidone dosing for pediatric delirium in children less than or equal to 2 years of age. Annals of Pharmacotherapy, 54(5), 464–469. https://doi.org/10.1177/1060028019891969
Gangopadhyay, M., Smith, H., Pao, M., Silver, G., Deepmala, D., De Souza, C., Garcia, G., Giles, L., Denton, D., Jacobowski, N., Pandharipande, P., & Fuchs, C. (2017). Development of the vanderbilt assessment for delirium in infants and children to standardize pediatric delirium assessment by psychiatrists. Psychosomatics, 58(4), 355–363. https://doi.org/10.1016/j.psym.2017.03.006
Groves, A., Traube, C., & Silver, G. (2016). Detection and management of delirium in the neonatal unit: A case series. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-3369
Hardin, B.G, McCarter, A, Hamrick, S.E.G. (2024) A Delirium prevention and management
initiative: Implementing a best practice recommendation for the NICU. Neonatal
Network, 43 (1),19-34.
Harris, J., Ramelet, A.-S., van Dijk, M., Pokorna, P., Wielenga, J., Tume, L., Tibboel, D., & Ista, E. (2016). Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: An espnic position statement for healthcare professionals. Intensive Care Medicine, 42(6), 972–986. https://doi.org/10.1007/s00134-016-4344-1
Ista, E., Traube, C., de Neef, M., Schieveld, J., Knoester, H., Molag, M., Kudchadkar, S. R., & Strik, J. (2023). Factors associated with delirium in children: A systematic review and meta-analysis. Pediatric Critical Care Medicine, Publish Ahead of Print. https://doi.org/10.1097/pcc.0000000000003196
Liviskie, C., & McPherson, C. (2021). Delirium in the nicu: Risk or reality? Neonatal Network, 40(2), 103–112. https://doi.org/10.1891/0730-0832/11-t-727
Malas, N., Brahmbhatt, K., McDermott, C., Smith, A., Ortiz-Aguayo, R., & Turkel, S. (2017). Pediatric delirium: Evaluation, management, and special considerations. Current Psychiatry Reports, 19(9). https://doi.org/10.1007/s11920-017-0817-3
Michel, J., Schepan, E., Hofbeck, M., Engel, J., Simma, A., & Neunhoeffer, F. (2022). Implementation of a delirium bundle for pediatric intensive care patients. Frontiers in Pediatrics, 10.
Norman, S. L., & Taha, A. A. (2019). Delirium knowledge, self-confidence, and attitude in pediatric intensive care nurses. Journal of Pediatric Nursing, 46, 6–11. https://doi.org/10.1016/j.pedn.2019.01.013
Paterson, R. S., Kenardy, J. A., Dow, B. L., De Young, A. C., Pearson, K., Aitken, L. M., & Long, D. A. (2021a). Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care. Australian Critical Care, 34(3), 226–234. https://doi.org/10.1016/j.aucc.2020.07.012
Tarrell, A, Giles, L, Smith, B, Traube, C, Watt, K. (2024). Delirium in the NICU. Journal of
Perinatology. (44): 157-163.




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*Disclaimer*: This video is intended for educational purposes only and while we strive to give the most accurate information, errors may occur. Subsequently, this video should not be a replacement for medical advice.