45 - Prevalence of Delirium and Associated Risk Factors in a Level 4 Neonatal Intensive Care Unit

Publication Number: 1038.45

Abby Begezda, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Charu Venkatesan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Stacey L. Dornette, Cincinnati Children's Hospital Medical Center, Harrison, OH, United States; Stephen Deptola, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Brianna Hemmann, Cincinnati Children's Hospital Medical Center, Amelia, OH, United States; DonnaMaria E. Cortezzo, Connecticut Children's Medical Center, Hartford, CT, United States

Background: Delirium is a neurobehavioral syndrome of cerebral dysfunction characterized by a change or fluctuation in baseline mental status, attention, cognition or level of consciousness. While extensively studied in adult and pediatric intensive care units (ICUs), its recognition in the neonatal intensive care unit (NICU) remains limited. Understanding the prevalence and associated risk factors of neonatal delirium can improve clinical recognition and management in the NICU.

Objective: Identify the prevalence of delirium and associated factors in patients 35 weeks’ corrected gestational age (CGA) and older in a level IV NICU.

Design/Methods: This is an IRB-approved, retrospective cohort study of all neonates ≥35 weeks’ CGA admitted to the Cincinnati Children’s level IV NICU from July 1, 2023 to June 30, 2024. All neonates meeting inclusion criteria were assessed for delirium using Cornell Assessment of Pediatric Delirium (CAPD) scoring, which has been validated for use in neonates. CAPD scoring was completed twice daily by trained NICU staff and a score ≥9 was considered indicative of delirium.

Results: 694 patients met inclusion criteria and received CAPD scoring. 72 patients (10%) had CAPD score > 9. The mean gestational ages of patients with and without scores indicative of delirium scores were not significantly different (34.7 weeks and 34.6 weeks, respectively). Exposure to classes of medication with neurotoxic effects were significantly associated with CAPD score > 9 at any time point during hospitalization: benzodiazepines (RR=9.06; OR=17.85; [p < 0.0001]); opioids (RR=21.96, OR=27.02; [p < 0.0001]); anticholinergics (RR=8.79; OR=34.1; [p < 0.0001]); steroids (RR=3.21, OR=3.74; [p < 0.0001]). The mean length of hospital stay was significantly different between the patient groups (t = 5.97, p < 0.0001).

Conclusion(s): Our findings show that it is feasible to institute delirium scoring in a level IV NICU. 10% of patients had delirium during the NICU stay. Patients with prolonged hospital admissions and exposure to polypharmacy are at a significantly increased risk of developing delirium.