Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment
In this paper we explore refractory agitation in the neonatal population, focusing on the limitations of existing evidence on appropriate prevention, diagnosis, and treatment options. We highlight seven patients identified in an urban single-center level IV NICU with agitation unresponsive to standa...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1504619/full |
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| author | Kim Beatty Eunsung Cho Jessica Biggs Shawnee Daniel-McCalla Johana Diaz |
| author_facet | Kim Beatty Eunsung Cho Jessica Biggs Shawnee Daniel-McCalla Johana Diaz |
| author_sort | Kim Beatty |
| collection | DOAJ |
| description | In this paper we explore refractory agitation in the neonatal population, focusing on the limitations of existing evidence on appropriate prevention, diagnosis, and treatment options. We highlight seven patients identified in an urban single-center level IV NICU with agitation unresponsive to standard non-pharmacologic interventions and escalation of standard neurosedative medications. We analyzed baseline characteristics and clinical courses of these patients with the aim to identify the NICU subpopulation at greatest risk for development of refractory agitation and to gain insight into the potential benefits of alternative medical management of agitation on later neurodevelopment. Based on these experiences we propose a practical approach to infants at increased risk for refractory agitation including standardized screening guidelines and a clinical pathway for developmentally appropriate non-pharmacologic and pharmacologic management. |
| format | Article |
| id | doaj-art-9d67a4a6c0294fa5b9171130a5b8c19f |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-9d67a4a6c0294fa5b9171130a5b8c19f2025-08-20T03:05:01ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-02-011310.3389/fped.2025.15046191504619Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatmentKim Beatty0Eunsung Cho1Jessica Biggs2Shawnee Daniel-McCalla3Johana Diaz4Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United StatesDivision of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United StatesDepartment of Pharmacy, University of Maryland Medical Center, Baltimore, MD, United StatesDepartment of Pharmacy, University of Maryland Medical Center, Baltimore, MD, United StatesDivision of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United StatesIn this paper we explore refractory agitation in the neonatal population, focusing on the limitations of existing evidence on appropriate prevention, diagnosis, and treatment options. We highlight seven patients identified in an urban single-center level IV NICU with agitation unresponsive to standard non-pharmacologic interventions and escalation of standard neurosedative medications. We analyzed baseline characteristics and clinical courses of these patients with the aim to identify the NICU subpopulation at greatest risk for development of refractory agitation and to gain insight into the potential benefits of alternative medical management of agitation on later neurodevelopment. Based on these experiences we propose a practical approach to infants at increased risk for refractory agitation including standardized screening guidelines and a clinical pathway for developmentally appropriate non-pharmacologic and pharmacologic management.https://www.frontiersin.org/articles/10.3389/fped.2025.1504619/fullICU deliriumneonatal agitationopiodsclonidinebenzodaizepine |
| spellingShingle | Kim Beatty Eunsung Cho Jessica Biggs Shawnee Daniel-McCalla Johana Diaz Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment Frontiers in Pediatrics ICU delirium neonatal agitation opiods clonidine benzodaizepine |
| title | Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment |
| title_full | Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment |
| title_fullStr | Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment |
| title_full_unstemmed | Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment |
| title_short | Refractory agitation in the NICU: challenges in prevention, diagnosis, and treatment |
| title_sort | refractory agitation in the nicu challenges in prevention diagnosis and treatment |
| topic | ICU delirium neonatal agitation opiods clonidine benzodaizepine |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1504619/full |
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