Clinical Characteristics of Patients with Iatrogenic Withdrawal Syndrome Aged 1 Month to 17 Years
Vallejos-Mita Gloria Martha*, Velasco-Pérez Georgina and Duarte-Castro Angelica
ABSTRACT
Introduction: Sedoanalgesia aims to relieve anxiety, agitation, and pain, where prolonged use and high doses of opioids and benzodiazepines can cause dependence, tolerance, and withdrawal, thereby prolonging hospital stay and increasing costs for the healthcare system. The incidence of iatrogenic withdrawal síndrome (IWS) in pediatric patients is approximately 57%-64.6% (frequently associated with fentanyl and midazolam), so it is important to identify and adequately manage the clinical features associated with this syndrome. It can be identified and assessed using validated scales in the pediatric population. The question of how to prevent and treat it remains uncertain.
To date, there is no updated data on IWS in pediatrics in general, except in neonates. The findings of this research aim to establish a knowledge base that could facilitate the creation of clinical guidelines and promote continuous improvement in pediatric care.
Objective: To describe the clinical manifestations of iatrogenic withdrawal syndrome as well as the dose and administration time of fentanyl and midazolam in patients aged one month to 17 years at the National Institute of Pediatrics from January 2022 to December 2023.
Materials and Methods: An observational, cross-sectional, retrospective, and descriptive study with non-probabilistic, non-random, convenience sampling was conducted with patients aged 1 month to 17 years with iatrogenic withdrawal syndrome from January 2022 to December 2023. Data were collected in Excel 2020 and exported to SPSS version 21 for statistical analysis, using descriptive statistics to present demographic characteristics, drugs, dosages, administration time, and rating scale scores applied by the treating service and pain clinic that led to the diagnosis of iatrogenic withdrawal syndrome.
Results: There were 46 cases of iatrogenic withdrawal syndrome, 21 female patients (45.7%) and 25 male patients (54.3%), mostly aged 1 to 6 months (47.8%), assessed by pediatric pain specialists using the SOS scale with 27 patients (58.7%) and WAT-1 with 19 patients (41.3%). The most frequent clinical manifestations were irritability (100%), which occurred mostly with withdrawal or dose reduction of fentanyl (54.3%), followed by midazolam and buprenorphine (each 15.2%)
