Pediatric Anesthesia最新文献

{"title":"Pharmacokinetic and Pharmacodynamic Modeling of Clonidine and Midazolam for Sedation in Pediatric Intensive Care.","authors":"Maddlie Bardol, Yucheng Sheng, Manuel Baarslag, Adriana Ceci, Frank Dörje, Mari-Liis Ilmoja, Peter Larsson, Per-Arne Lönnqvist, Tuuli Methsvat, Pavla Pokorna, Wolfgang Rascher, Joost van Rosmalen, Michael Schroth, Alessandra Simonetti, Dick Tibboel, Irmgard Toni, Catherine Tuleu, Thomas M K Völkl, Brian J Anderson, Stefan Wimmer, Joseph F Standing, Antje Neubert","doi":"10.1111/pan.70050","DOIUrl":"https://doi.org/10.1111/pan.70050","url":null,"abstract":"<p><strong>Background: </strong>Clonidine and midazolam are routinely used in the pediatric intensive care unit for pain and sedation management, but target concentration and optimal dose are poorly defined for both drugs. The CloSed study is a multicenter, double-blind, randomized, active-controlled noninferiority trial with a 1:1 randomization between clonidine and midazolam.</p><p><strong>Aims: </strong>Data from the prematurely terminated CloSed trial were used to study the population pharmacokinetic-pharmacodynamic relationships for clonidine and midazolam to inform the optimal use of both drugs in mechanically ventilated children.</p><p><strong>Methods: </strong>Twenty-eight patients (0-6 years) were included; 13 received midazolam, and 15 received clonidine. Morphine was administered to all patients as background analgesia. A total of 317 and 306 observed COMFORT-B scores for midazolam and clonidine, respectively, were available to build the pharmacokinetic-pharmacodynamic model. Pharmacokinetic models were developed using findings from previously published pharmacokinetic studies to augment the trial data. A one-compartment model described clonidine pharmacokinetics, while a single compartment for midazolam and its metabolite described its pharmacokinetics. A joint inhibitory sigmoid model that included a postanesthesia effect was used to describe the concentration-effect relationship, using the COMFORT-B score as the pharmacodynamic endpoint.</p><p><strong>Results: </strong>The final models adequately described the observed data. Simulations based on the final models showed that a clonidine dose of 4 μg/kg loading dose followed by a 3 μg/kg/h infusion, and a midazolam dose of 200 μg/kg loading dose followed by a 200 μg/kg/h infusion would be required to achieve adequate sedation.</p><p><strong>Conclusion: </strong>The CloSed data suggest that higher doses of clonidine and midazolam than are commonly used in clinical practice should be considered to provide adequate sedation in critically ill children.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Improvement Protocol to Reduce Excessive Postoperative Recovery Following Cleft Palate Repair.","authors":"Balvindar Kaur, Geoff Frawley, David Chong, Jonathon Burge","doi":"10.1111/pan.70019","DOIUrl":"10.1111/pan.70019","url":null,"abstract":"<p><strong>Background: </strong>Primary cleft palate repair in infants is frequently associated with postoperative pain and respiratory complications. As a result, prolonged post-anesthetic care unit (PACU) length of stay is common, which in turn delays time to first feed and may increase hospital length of stay.</p><p><strong>Setting: </strong>Tertiary Institutional.</p><p><strong>Participants: </strong>Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and December 2024.</p><p><strong>Method: </strong>A multidisciplinary quality improvement (QI) study incorporating a series of iterative Plan-Do-Study-Act (PDSA) cycles focused on anesthetic management of children undergoing cleft palate repair at The Royal Children's Hospital. The primary components of the interventions were: (1) implementation of a consistent multimodal analgesic protocol, (2) selective use of above-elbow arm splints, and (3) intraoperative infusion of dexmedetomidine. The primary outcome measure was mean PACU length of stay. Secondary outcomes were the incidence of pain or distress, airway obstruction, hypoxemia, or unplanned intensive care admission.</p><p><strong>Results: </strong>Four hundred and thirty-four patients (mean 14.7 months, 10.1 kg weight) were included. Standardization of the anesthetic approach resulted in a 16% reduction in mean PACU stay, rationalization of the use of the arm splint stage a 15% reduction, and intraoperative dexmedetomidine an 11% reduction in PACU stay. The overall incidence of pain or distress requiring opiate intervention was 31% with no significant reductions in incidence with anesthetic standardization (32%), rationalization of splint use (32%) and dexmedetomidine infusion (26%). Overall, 23% of patients had a perioperative adverse respiratory event in the first hour post-surgery with a significant reduction in the dexmedetomidine phase (12%) but non-significant decreases in other phases. Unexpected pediatric intensive care intervention was reduced from 7.3% to 1.2% with significant reductions in the splint and dexmedetomidine phases.</p><p><strong>Conclusions: </strong>The three components of this study combined to effectively reduce excessive PACU stay. Implementation of these recommendations is expected to be sustainable in the future and could be applied by other units involved in cleft palate repair.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"838-847"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Variation in Intraoperative Management of Pediatric Organ Donation After Brain Death: A Retrospective Observational Multicenter Perioperative Outcomes Group Study.","authors":"Phil Y Yao, Abhijit V Lele, Michael J Souter, Emily A Vail, Xinyao G deGrauw, Christine T Fong, Bhiken I Naik, Robert B Schonberger, Vikas N O'Reilly-Shah","doi":"10.1111/pan.70064","DOIUrl":"https://doi.org/10.1111/pan.70064","url":null,"abstract":"<p><strong>Background: </strong>There remains a critical shortage of pediatric organ donors and there is a gap in understanding of optimal perioperative management to optimize donor organ outcomes for this valuable resource.</p><p><strong>Aims: </strong>To survey practice patterns for intraoperative management of pediatric (age < 18 years) brain-dead donors during organ recovery procedures.</p><p><strong>Methods: </strong>This retrospective observational study included organ recovery cases from 24 centers included in the Multicenter Perioperative Outcomes Group (MPOG) cohort in the United States from 2014 to 2020. Practice variation was evaluated using descriptive statistics, Fleiss' kappa, and logistic regression for between-group comparisons for volume-based analysis (case volume < 10 or ≥ 10) without adjustment for multiple comparisons.</p><p><strong>Results: </strong>A total of 231 cases were included in this analysis. The median case volume for the Higher-Volume (≥ 10 cases) group was 25 [IQR 17, 46] cases and 7 [IQR 3, 8] cases for the Lower-Volume (< 10 cases) group. Descriptive analyses identified differences in case volume, race, and administration of steroids and vasoactives (bolus and infusion). The Fleiss' kappa scores were negative across all medications administered, suggesting a lack of within-group agreement. The odds ratio for steroid administration in the Lower-Volume group was 0.319 (95% CI: 0.116-0.745, p = 0.014).</p><p><strong>Conclusions: </strong>This study found substantial practice variation across MPOG centers grouped based on case volume frequency for organ recovery procedures in pediatric donation after brain death. A major limitation of this study is the inability to correlate perioperative management with organ recipient outcomes. The main takeaway is an opportunity to improve consistency in perioperative management for brain-death donors from case classification to medication administration that reflects an understanding of brain death physiology.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Review of Intraoperative Hypotension and Perioperative Angiotensin Inhibitor Use in Pediatrics.","authors":"Zhe Amy Fang, Jonathan Palmer, Kristie Geisler, Abby V Winterberg, Jamie Sinton","doi":"10.1111/pan.70004","DOIUrl":"10.1111/pan.70004","url":null,"abstract":"<p><strong>Background: </strong>Perioperative management of angiotensin inhibitors is contentious in adults and understudied in children. Perioperative angiotensin inhibitor management in pediatrics cannot be extrapolated from adult literature because of dynamic neurohormonal pediatric physiology and uniquely pediatric indications for angiotensin inhibitor therapy. There is limited evidence for whether angiotensin inhibitors should be held in the perioperative setting in the pediatric population.</p><p><strong>Aims: </strong>The aim of this study is to assess whether perioperative angiotensin inhibitor use is associated with intraoperative hypotension in the pediatric population.</p><p><strong>Methods: </strong>This is a single center, retrospective cohort study. Data collection comprised demographics, angiotensin inhibitor dose timing and intraoperative blood pressure. Participants patients were divided into two groups based on recency of dose of angiotensin inhibitor, Recents had angiotensin inhibitor therapy within 2 days and Remotes had angiotensin inhibitor therapy between 2 and 30 days. Logistic regression with covariate adjustment and propensity score matching were performed to control confounding. Regression analysis and Chi-squared test were used to compare the incidence of hypotension between the two groups.</p><p><strong>Results: </strong>Four hundred ninety patients were included in the study prior to propensity score matching. We found the overall incidence of hypotension to be 29% (142/490). There was no difference in the incidence of hypotension by recency of angiotensin inhibitor dose between the two groups prior to matching, Recents 25.4% (59/232), Remotes 32% (83/258), p = 0.06. Adjusting for covariates, the odds ratio for hypotension is 0.73 (0.48-1.10, p = 0.129) for Recents compared to Remotes. After propensity score matching, there were 184 patients in each group. There remained no difference in the incidence of hypotension in the between the two groups, Recents 27% (50/184), Remotes 33% (61/184), p = 0.13.</p><p><strong>Conclusion: </strong>We found no evidence to support the practice of abstaining from angiotensin inhibitor use in pediatric surgical patients for concern of intraoperative hypotension.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"848-855"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do You Really Need a Beer to Collaborate?","authors":"Britta S von Ungern-Sternberg, Clyde Matava","doi":"10.1111/pan.70033","DOIUrl":"10.1111/pan.70033","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"801-802"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of the Properties of an Herbal Admixture (BabySed) During Trans-Thoracic Echocardiography in Children Under Six Years Old, and Comparison to Chloral Hydrate.","authors":"Kosar Yazdani, Zahra Jalili, Fatemeh Heydarpour, Foroud Shahbazi, Lida Shojaei","doi":"10.1111/pan.70030","DOIUrl":"10.1111/pan.70030","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the efficacy and safety of herbal mixture versus chloral hydrate for sedation induction in the pediatric population undergoing echocardiography.</p><p><strong>Patients and methods: </strong>Seventy pediatric patients referred to the echocardiography clinic were randomly allocated to receive either the herbal mixture or chloral hydrate for sedation induction. Sedation adequacy, echocardiography completion, onset and duration of action, and adverse effects were compared between the two groups from April 2022 to July 2022.</p><p><strong>Results: </strong>Over a 4-month period, 70 patients received chloral hydrate (50 mg/kg) or an herbal admixture based on the company leaflet. The mean age of the patients was 20.95 ± 16.63 months, with the majority being male (58.3%). Adequate sedation was similar between the two groups. A Ramsay sedation score of ≥ 4 was achieved in 90% of the patients in the herbal product group and in 96.7% of the patients in the chloral hydrate group (OR: 0.31, relative risk 95% CI: 0.03-3.16, p:0.32). Oxygen desaturation and blood pressure fluctuations were not observed during the procedure or recovery. Chloral hydrate had a shorter onset of action and a longer duration of action (p = 0.029, p < 0.001), respectively and was associated with higher adverse effects (p < 0.001).</p><p><strong>Conclusions: </strong>The results of our study suggest that an herbal mixture can be effectively used for procedural sedation during echocardiography in children.</p><p><strong>Trial registration: </strong>IRCT20200202046335N2.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"822-830"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Phrenic Nerve Palsy in Pediatric Costoclavicular Brachial Plexus Block.","authors":"Julio La Palma, Hipólito Labandeyra, Gregory Contreras-Pérez, Maite Luchinni, Xavier Sala-Blanch","doi":"10.1111/pan.70009","DOIUrl":"10.1111/pan.70009","url":null,"abstract":"<p><p>The costoclavicular brachial plexus block has gained relevance as a safe and effective regional anesthesia technique for upper limb orthopedic surgery in adults, but data in pediatric populations remain limited. This study aimed to evaluate the incidence of phrenic nerve palsy associated with CBPB in pediatric patients. We conducted a descriptive observational study in 30 children undergoing upper limb orthopedic surgery. Diaphragmatic excursion was assessed before and after the block using M-mode ultrasound. No cases of phrenic nerve palsy were observed. Postoperative analgesia was effective, with minimal opioid consumption. These findings suggest that the costoclavicular brachial plexus block is a promising option in pediatric regional anesthesia. Further studies are needed to confirm its safety and efficacy.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":"35 10","pages":"872-873"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydromorphone Versus Fentanyl-Based Induction of Anesthesia for Postoperative Pain and Emergence Delirium in Children Undergoing Strabismus Surgery: A Randomized, Double-Blind Comparative Study.","authors":"Qiyuan Huang, Yongwei Su, Xiaohui Sun, Ruihao Zhou, Zhao Xu, Yang Chen, Xuejiao Bai, Guo Chen, Tao Zhu","doi":"10.1111/pan.70012","DOIUrl":"10.1111/pan.70012","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the effects of hydromorphone and fentanyl-based induction of anesthesia for immediate postoperative analgesia in pediatric patients.</p><p><strong>Patients and methods: </strong>This was a prospective, double-blind, randomized controlled trial. 186 preschool children aged 3 to 7 years old scheduled for strabismus surgery were randomized to receive hydromorphone 0.02 mg/kg (hydromorphone group; n = 80) or fentanyl 3 μg/kg (fentanyl group; n = 80). The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) pain score at extubation. Secondary outcomes included the incidence of postoperative emergence delirium (ED), the proportion of subjects who received rescue analgesia, Ramsay sedation scores, heart rate, mean arterial pressure, and SpO₂ in post-anesthesia care unit, and perioperative adverse events.</p><p><strong>Results: </strong>From November 10, 2020, to May 26, 2022,186 patients at West China Hospital were enrolled, 153 (37.5% male) of whom received administration of fentanyl (n = 76) or hydromorphone (n = 77). The hydromorphone group showed lower FLACC pain scores at the time of extubation (median [IQR], hydromorphone vs. fentanyl, 0 [0-0] vs. 0 [0-1], Mann-Whitney U = 2457.0, Z = -2.469, p = 0.014). The incidence of ED in the hydromorphone group was statistically lower than that in the fentanyl group (75.3% vs. 93.4%, p = 0.004, relative risk and 95% CI was 0.8 (0.7, 0.9)). Other secondary outcomes were comparable between the two groups.</p><p><strong>Conclusion: </strong>Hydromorphone administration during induction may improve postoperative pain control and reduce the incidence of ED in PACU after pediatric strabismus surgery.</p><p><strong>Trial registration: </strong>This study was registered at the Chinese Clinical Trials Register (www.chictr.org.cn) (number: ChiCTR2000039555, date of registration: 31/10/2020).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"803-809"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamics of Oxygen Reserve Index and Arterial Oxygen Partial Pressure in Children: A Prospective Observational Study.","authors":"Jin-Tae Kim, Jung-Bin Park, Sang-Hwan Ji, Young-Eun Jang, Eun-Hee Kim, Hee-Soo Kim, Ji-Hyun Lee","doi":"10.1111/pan.70014","DOIUrl":"10.1111/pan.70014","url":null,"abstract":"<p><strong>Aims: </strong>The Oxygen Reserve Index (ORI) is a novel, noninvasive parameter that reflects moderate hyperoxic states. However, its relationship with PaO₂ in the pediatric population remains poorly understood. We investigated the ORI-PaO₂ relationship during pediatric cardiac surgery and identified its influencing factors.</p><p><strong>Methods: </strong>This prospective observational study included 98 pediatric patients (< 7 years of age) who underwent cardiac surgery for congenital heart defects. ORI and PaO₂ were measured at FiO₂ levels of 0.21, 0.5, and 0.8, both before and after cardiopulmonary bypass (CPB). Linear mixed models and regression analyses were used to examine the relationship between ORI and PaO₂ by incorporating covariates such as hemoglobin (Hb), ejection fraction (EF), and perfusion index (PI). Locally weighted regression analysis was conducted to identify potential PaO₂ thresholds influencing this relationship.</p><p><strong>Results: </strong>A total of 487 data samples were analyzed. A nonlinear relationship between ORI and PaO₂ was observed, with a threshold of 245 mmHg dividing the data into two distinct ranges. Pearson correlation coefficients between ORI and PaO₂ were significant in both ranges: 0.516 (PaO₂ ≤ 245 mmHg, p < 0.001) and 0.151 (PaO₂ > 245 mmHg, p = 0.035). Although Hb level and EF showed no impact, only PI had a mildly negative relationship with ORI before CPB. The relationship between ORI and PaO₂ remained consistent across both pre- and post-CPB periods (r² = 0.304 and 0.337, respectively).</p><p><strong>Conclusion: </strong>ORI consistently correlates with PaO₂ in children undergoing cardiac surgery, is unaffected by Hb or EF, and may serve as a useful tool for monitoring oxygenation trends.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT03130023.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"810-815"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Nasotracheal Versus Orotracheal Intubation in Neonates After Cardiopulmonary Bypass Surgery: A Retrospective Cross-Sectional Analysis.","authors":"Peggy Vogt, Laura Downey, Michelle E Gleason, Lily D Dresner, Shanelle Clark, Subhadra Shashidharan, Justin Long","doi":"10.1111/pan.70010","DOIUrl":"10.1111/pan.70010","url":null,"abstract":"<p><strong>Background: </strong>Institutions variably utilize oral (OI) versus nasal intubation (NI) for neonatal cardiac surgery. The proposed advantages of NI include a lower rate of endotracheal tube (ETT) dislodgement, decreased sedation requirements, and improved oral feeding. However, NI carries an additional risk of pressure injury and increased technical difficulty.</p><p><strong>Aims: </strong>The goal of this study was to evaluate whether NI was associated with decreased risk of ETT dislodgement or improved feeding outcomes versus OI.</p><p><strong>Methods: </strong>We performed a single center, retrospective, cross-sectional study of neonates intubated in the operating room undergoing cardiopulmonary bypass surgery from 2018 to 2020. Primary outcomes were unplanned extubation and oral feeding at discharge. Secondary outcomes included hospital length of stay, duration of intubation, otolaryngology (ENT) consult, skin breakdown related to the ETT, postoperative sedation medications, and adverse anesthesia induction events. Chi-squared and Fisher's exact tests were used for categorical data and Wilcoxon rank-sum tests for continuous data. Unadjusted results were calculated using univariate regressions. Adjusted results were calculated using linear mixed effect models and logistic regressions. Continuous outcomes were log transformed, and results adjusted for weight and surgeon. p < 0.05 was statistically significant.</p><p><strong>Results: </strong>Of the 179 patients, 49.8% (n = 89) were OI and 50.2% (n = 90) were NI. There was no difference in unplanned extubation, length of hospital stay, length of intubation, complications during induction, or percentage of exclusively oral feeding at the time of transfer from the intensive care unit or discharge from the hospital. There was a statistically significant difference in skin breakdown related to the ETT, where 89% of breakdown occurred in the NI group (p = 0.045, OR = 0.12, 95% CI [0.01, 0.65]). Sedation administration between the groups was similar.</p><p><strong>Conclusions: </strong>NI was not associated with improved exclusive oral feeding at discharge for neonatal cardiac surgical patients and may be associated with an increased risk of pressure injury in this single center, retrospective, cross-sectional study.</p><p><strong>Clinical implications: </strong>Several studies have investigated practice patterns and potential benefits of nasal intubation (NI) versus oral intubation (OI) in neonates undergoing cardiac surgical procedures; however, there is wide variation in national practice standards and unclear effects on postoperative feeding outcomes. At our high-volume cardiac center, we implemented a nasal intubation program for neonates as a quality improvement initiative. We found that NI was not associated with decreased risk of peri-operative unplanned extubation nor improved oral feeding outcomes at the time of hospital discharge.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"864-871"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}