136 - Costs and Outcomes Associated with the Administration of Intravenous Acetaminophen in Neonates after Esophageal Atresia and Tracheoesophageal Fistula Repair

Poster Number: 136
Publication Number: 136.1818

Background: Over the last decade, the intravenous (IV) formulation of acetaminophen (APAP) has gained popularity as a safe and effective first-line analgesic in the neonatal intensive care unit and is especially useful in peri-operative settings where oral agents are contraindicated. IV APAP in combination with morphine has been shown to lower the cumulative morphine dose in neonates undergoing major surgery compared to morphine alone. However, due to its ability to be administered intravenously, IV APAP commands a mean wholesale unit price of $0.029 per milligram (mg), nearly 17 times greater than the mean cost of $0.002 per mg of oral APAP.

Objective: Given the prolonged hospitalizations, in addition to variable LOS and outcomes associated with neonatal esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair, the primary objective was to examine the outcomes and costs associated with the use of IV APAP in combination with opioids versus opioids alone as a pain management strategy after EA/TEF repair.

Design/Methods: Data from the Pediatric Health Information System was used to examine 1,137 hospitalizations for EA/TEF repair from October 2015 to September 2018. Neonates administered opioids only, or IV APAP in combination with opioids as pain management were included.

Results: A total of 1,101 neonates were included in the study, with 537 neonates receiving only opioids, and 564 neonates receiving both opioids and IV APAP. The median length-of-stay (LOS) in the group receiving only opioids was 32.0 days, compared to 47.5 days in the group receiving opioids and IV APAP (p < 0.001). The mortality rate in patients given IV APAP was 4.1%, significantly lower than the 15.1% experienced by patients that did not receive IV APAP (p=0.03). Mean daily opioid use also decreased in the IV APAP group (2.6 mg vs 2.8 mg) (p < 0.001). Despite a longer median LOS, mean daily costs were decreased in the IV APAP group ($8,233 vs. $28,150) (p < 0.001).

Conclusion(s): The findings of our analysis show that the use of IV APAP in addition to opioids in our cohort of neonates undergoing EA/TEF repair is correlated with prolonged LOS but substantially improved mortality, as well as decreased mean daily costs and opioid use.