Assessment of Quetiapine for Managing Delirium in Paediatric Critical Care Patients Younger than 2 Years of Age
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Background: Delirium is a common complication of paediatric patients admitted to critical care units (CCU), leading to increased risk of morbidity and mortality. Children less than 2 years old are at a higher risk for developing delirium. For patients whose symptoms fail to improve, there is limited literature suggesting using quetiapine as an adjunct to nonpharmacological management for CCU delirium. Objectives: This study aimed to assess the effectiveness and short-term safety of quetiapine in patients less than 2 years old in the CCU at the Hospital for Sick Children. Methods: A retrospective chart review of patients less than 2 years old prescribed quetiapine in the CCU from July 2018 to November 2023 was completed to evaluate patients' characteristics, quetiapine dosing regimens, efficacy and short-term safety parameters. Results: Seventy-eight patients administered quetiapine in the CCU were included. Quetiapine use was more frequent in the Cardiac Critical Care Unit (n=62, 79.5%) compared to the Paediatric Intensive Care Unit (n=16, 20.5%). The median quetiapine course was 6 days (IQR: 2-23 days). Although Cornell Assessment of Pediatric Delirium (CAPD) scores during quetiapine therapy (mean=9.1, SD=3.86) were lower than scores before quetiapine (mean=13.0, SD=4.36), patients’ mean opioid and alpha agonist use did not differ during quetiapine therapy. Benzodiazepine use decreased during quetiapine (mean=0.22 mg of lorazepam/kg/day, SD=0.54) compared to before (mean=0.47mg of lorazepam/kg/day, SD=1.18). As benzodiazepine use is a risk factor for CCU delirium, this may have influenced patients’ CAPD scores. No adverse effects associated with quetiapine were observed. Conclusion: Patients receiving quetiapine for CCU delirium had a decrease in their CAPD scores, however, the decrease was modest and still indicative of delirium. Patients did not have changes in their opioid and alpha agonist use, but a decrease in benzodiazepine use was seen. Future research is required to standardize duration and weaning for quetiapine in this patient population and evaluate which CCU subpopulations would most benefit from quetiapine for delirium management.
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