Impact of Intravenous Methadone Dosing Schedule on Iatrogenic Withdrawal Syndrome in a Pediatric Intensive Care Unit

OBJECTIVE To compare median Sophia Observation withdrawal Symptoms scale (SOS) scores between intravenous methadone dosing scheduled every 6 hours or every 8 hours for iatrogenic withdrawal syndrome (IWS). METHODS This single-center, retrospective chart review evaluated patients aged 4 weeks through 18 years treated with intravenous methadone for IWS. Children admitted to the pediatric intensive care unit (PICU) of a tertiary care children’s hospital between August 2017 and July 2021 and treated for IWS for at least 48 hours were eligible for inclusion. Methadone dosing schedules were compared, with a primary outcome of median Sophia Observation withdrawal Symptoms (SOS) score during the first 24 hours after cessation of continuous fentanyl infusion. Secondary outcomes included PICU and general pediatric unit lengths of stay, extubation failure rates, and mortality. RESULTS Twenty patients met inclusion criteria, with 9 in the 6-hour dosing group. There was no difference in median SOS score, extubation failure, length of stay, or mortality between the 2 groups. CONCLUSIONS During the first 24 hours after cessation of continuous fentanyl, there appears to be no difference in IWS severity, as determined by bedside nurse scoring, between patients treated with intravenous methadone every 6 hours compared with every 8 hours. ABBREVIATIONS EMR, electronic medical record; IWS, iatrogenic withdrawal syndrome; OCH, John R. Oishei Children’s Hospital; PICU, pediatric intensive care unit; SOS, Sophia Observation withdrawal Symptoms scale.