NEONATAL CARE

Opioid stewardship and necrotizing enterocolitis

Neonatal opioid stewardship can be enhanced by identifying infants with surgically treated necrotizing enterocolitis (NEC) who are at the highest risk of requiring methadone treatment, according to a paper published in JAMA Network Open. NEC requiring surgical intervention is the most common reason for surgery in preterm neonates. Opioids are used to manage postoperative pain, with some infants requiring methadone to treat physiologic opioid dependence.

The researchers wanted to know if giving infants nonmethadone opioids after surgery would make them more likely to need methadone later.

They looked at information from 2,037 infants who had NEC surgery in different children's hospitals. About 11% needed methadone postoperatively. The researchers found that as the cumulative days an infant received nonmethadone opioids increased, the likelihood of methadone treatment increased.

The study also found that babies who needed methadone after surgery had to stay in the hospital longer, needed mechanical ventilation longer, and needed parenteral nutrition longer.

Reference: Keane OA, Zamora AK, Ourshalimian S, et al Opioid and methadone use for infants with surgically treated necrotizing enterocolitis. JAMA Netw Open. 2023;6(6). doi:10.1001/jamanetworkopen.2023.18910.

ANESTHESIA

New guidelines to improve medication safety

The Association of Anaesthetists has unveiled new guidelines to improve the safe management of medications within anesthesia departments.

The guidelines spotlight the pivotal role of well-defined institutional policies spanning various hospital domains, specifically focusing on anesthesia units. This accentuates the importance of seamless communication and collaborative teamwork among nurses to ensure safety in medication practices.

Nurses' involvement in medication administration aligns with the guidelines' emphasis on pharmacy departments selecting suppliers with stringent labeling practices and a consistent supply chain. This approach bolsters medication reliability and patient safety, a vital aspect of nursing care.

Moreover, the guidelines advocate embracing technology-driven solutions to minimize errors during medication management. Nurses' hands-on involvement in implementing and adapting to these solutions is key to ensuring accurate and secure medication administration.

The guidelines also shed light on the advantages of prefilled syringes, known for their potential in reducing errors and enhancing administration precision. Nurses' active integration of these syringes can lead to smoother medication practices and improved patient care.

Reference: Kinsella SM, Boaden B, El-Ghazali S, et al Handling injectable medications in anaesthesia. Anaesthesia. [e-pub July 26, 2023]

EPILEPSY

How antiepileptic drugs affect pregnancy and development

A recent study, the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD), has shed light on the potential effects of antiepileptic drugs (AEDs) on both pregnancy outcomes and children's neurodevelopment.

Carried out across 20 specialized epilepsy centers in the US between December 2012 and January 2016, the study enrolled 456 pregnant women, 351 with epilepsy and 105 without the condition.

The study's primary objective was to examine children's cognitive abilities at the age of 3, assessed through a Verbal Index score. The score was calculated based on various standardized tests, and the results indicated no significant differences in Verbal Index scores between children born to mothers with epilepsy (mean score 102.7) and those born to mothers without epilepsy (mean score 102.3).

Several factors were found to influence Verbal Index scores, including maternal intelligence quotient, education, postbirth anxiety, gestational age at enrollment, child's gender, and ethnicity.

Secondary analyses demonstrated that exposure to AEDs during pregnancy did have varying effects on cognitive measures, depending on the specific medication used. The study also highlighted the importance of addressing maternal postbirth anxiety, suggesting the need for timely screening and interventions during pregnancy and postpartum.

Reference: Meador KJ, Cohen MJ, Loring DW, et al Cognitive outcomes at age 3 years in children with fetal exposure to antiseizure medications (MONEAD study) in the USA: a prospective, observational cohort study. Lancet Neurol. 2023;22(8):712-722. doi:10.1016/s1474-4422(23)00199-0.

ACUTE SINUSITIS

Antibiotics less useful for those without detected bacterial pathogens

Children with acute sinusitis but without nasopharyngeal bacterial pathogens detected did not benefit as much from antibiotic treatment as those with detected pathogens in a study published in JAMA.

The randomized clinical trial involved 515 children ages 2 to 11 years diagnosed with acute sinusitis and aimed to assess the effectiveness of antibiotic therapy in specific subgroups. The study was conducted between February 2016 and April 2022 at primary care offices in the US.

The trial compared oral amoxicillin and clavulanate treatment to a placebo for 10 days. The primary outcome was the symptom burden based on daily symptom scores 10 days after diagnosis. The results showed that children in the antibiotic group had significantly lower mean symptom scores than those in the placebo group. Additionally, the time to symptom resolution was shorter for children receiving antibiotics.

The study found that children without nasopharyngeal bacterial pathogens detected did not benefit as much from antibiotic treatment as those with detected pathogens. The presence of colored nasal discharge did not significantly impact the efficacy of antibiotic treatment. This suggests that testing for specific bacteria on presentation could be a strategy to reduce unnecessary antibiotic use in cases of acute sinusitis.

Reference: Shaikh N, Hoberman A, Shope TR, et al Identifying children likely to benefit from antibiotics for acute sinusitis. JAMA. 2023;330(4):349-358. doi:10.1001/jama.2023.10854.

PREGNANCY

Folic acid supplementation reduces neural tube defects

Following a thorough evidence assessment, the US Preventive Services Task Force (USPSTF) has concluded that folic acid supplementation brings about a substantial net benefit in decreasing the risk of neural tube defects in offspring.

These congenital malformations affect around 3,000 pregnancies annually in the US. They are often linked to insufficient folate levels in the body, making folic acid supplementation a critical consideration for individuals planning to become pregnant or who could conceive.

The task force has classified the certainty of this finding as high.

As a result, the USPSTF recommends that all individuals planning to become pregnant or are at the stage where they can conceive should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. Daily folic acid supplementation should begin at least 1 month prior to anticipated conception and continue through the first 2 to 3 months of pregnancy. By integrating this simple measure into pre-pregnancy routines, individuals can significantly contribute to reducing neural tube defect occurrences.

By adhering to this guidance, nurses can play a vital role in guiding prospective parents toward healthier pregnancies and ensuring the well-being of future generations.

Reference: Barry MJ, Nicholson WK, Silverstein M, et al Folic acid supplementation to prevent neural tube defects. JAMA. 2023;330(5):454-459. doi:10.1001/jama.2023.12876.

COVID-19 VACCINES

mRNA-1273 vs. BNT162b2

A recent retrospective cohort study conducted on adults ages 66 years and older compared the safety profiles of two mRNA COVID-19 vaccines: mRNA-1273 and BNT162b2. The study utilized a linked database of community pharmacy and Medicare claims data to shed light on potential adverse events associated with these vaccines.

The study included 6,388,196 eligible individuals, with a mean age of 76.3 years, and was conducted between December 2020 and July 2021. The findings revealed that the mRNA-1273 vaccine demonstrated a slightly lower risk of adverse events than BNT162b2. Specifically, the mRNA-1273 vaccine was associated with reduced risks of pulmonary embolism and various adverse events, particularly among individuals categorized as nonfrail.

Moreover, mRNA-1273 exhibited a lower risk of being diagnosed with COVID-19 in comparison to BNT162b2. However, the individuals' frailty levels influenced the extent of this benefit. The study's results emphasize the need for comprehensive safety assessments of COVID-19 vaccines, especially among older adults.

Reference: Harris DA, Hayes KN, Zullo AR, et al Comparative risks of potential adverse events following COVID-19 mRNA vaccination among older US adults. JAMA Netw Open. 2023;6(8). doi:10.1001/jamanetworkopen.2023.26852.