54 - Neonatal Delirium: A Survey-Based Assessment of the Current State of Knowledge and Management Strategies among Neonatologists and Neonatal-Perinatal Medicine Fellows in the United States of America

Publication Number: 1047.54

Sruti Uppuluri, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Leslie M.. Harris, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Lauren Little, Rush University, Chicago, IL, United States; Kaitlyn Riffel, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Chani Traube, Weill Cornell Medicine, New York, NY, United States; Beverley Robin, Rush University Medical Center Simulation Center, Chicago, IL (ORD), IL, United States

Background: Delirium is well-described in pediatric patients but overlooked in the neonatal intensive care unit (NICU). It is linked to poor outcomes and is a modifiable risk factor. Thus, recognizing and understanding neonatal delirium (ND) is essential.

Objective: We aimed to assess US neonatologists’ and NICU fellows’ knowledge about ND and describe current ND management strategies. Secondary aims were to compare objective knowledge, perceived knowledge, and confidence in identifying and managing ND between groups, evaluate predictors of objective knowledge, and assess relationships between perception of knowledge and confidence.

Design/Methods: We electronically distributed an anonymous cross-sectional 31-item REDCap survey to physicians via the AAP Section on NPM, the organization of Trainees and Early Career Neonatologists, and snowball method. Objective knowledge was quantified by correct responses; incorrect knowledge by incorrect responses. Data were analyzed using SPSS 30.0 with independent samples t-tests and general linear models.

Results: There were 225 complete surveys: 134 (27 medical directors) by neonatologists and 91 by fellows. Most medical directors (81%) oversaw NICUs that did not screen patients for ND. Groups did not differ on objective knowledge scores (p=.971), confidence in managing or identifying ND (p=.941 and p=.841, respectively), or perceived knowledge (p=.774). Fellows endorsed fewer incorrect responses (M= 1.99; SD=1.53) than did neonatologists (M=2.99; SD=1.99, p<.001). Significant predictors of objective knowledge were age (p <.001), practice environment (p <.01), average census (p <.05), and confidence in managing ND (p <.001). Mid-career neonatologists (age 30-50 years) scored highest among age groups. Those in university-based and higher-census units and with higher confidence in managing ND showed increased objective knowledge scores.

Conclusion(s): Objective knowledge and confidence were comparable between groups, although neonatologists had more incorrect responses. Greater accuracy among fellows may reflect recent exposure to delirium in pediatric settings in residency. Clinicians who were mid-career, university-based, and/or practicing in high census units showed higher knowledge and confidence in managing ND, suggesting that greater exposure via patient volume and academic practices improves understanding of ND. Lack of ND screening in most NICUs highlights limited awareness about ND. Educational interventions and further studies in patients hospitalized in the NICU are needed to promote understanding of ND, leading to improved management and patient outcomes.