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Prospective clinical audit of chloral hydrate administration practices in a neonatal unit

Authors

  • Sharon Cruise,

    1. School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Island, United Kingdom
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  • Dorothy Tam-Chan,

    1. School of Nursing, The University of Melbourne
    2. Royal Children's Hospital
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  • Denise Harrison,

    1. School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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  • Linda Johnston

    Corresponding author
    1. School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Island, United Kingdom
    2. School of Nursing, The University of Melbourne
    3. Murdoch Children's Research Institute, Melbourne, Victoria, Australia
      Professor Linda Johnston, School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK. Fax: +44 (0)28 9097 5878; email: linda.johnston@qub.ac.uk
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  • Conflict of interest: None.

Professor Linda Johnston, School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK. Fax: +44 (0)28 9097 5878; email: linda.johnston@qub.ac.uk

Abstract

Aim:  Chloral hydrate is generally considered a safe and effective single dosing procedural sedative for neonates in the clinical setting. However, its safety profile as a repetitive dosing maintenance sedative is largely unknown. This study aimed to document current administration practices of chloral hydrate in the Neonatal Unit, Royal Children's Hospital, Melbourne, Australia, over a 6-month period.

Methods:  Patients who had been prescribed chloral hydrate during the specified audit period were recruited into the study and prospectively followed for a period of 28 days, or until they were discharged from the unit. Demographic data were collected on recruitment, and daily documentation of chloral hydrate administration was recorded.

Results:  A total of 238 doses of chloral hydrate were administered to a cohort of 32 patients during the study period. The majority of the audited doses (84%) were ordered as repeating doses. Doses were more likely to be given at night than during the day, and the median dosage for repetitive dosing was found to be above the study site's recommended dosing range. Pre-dose and/or post-dose assessment of distress/agitation accompanied dosage approximately half of the time. The audit did not reveal any recognisable pattern of sedation maintenance or weaning process for patients who received multiple doses.

Conclusions:  Health-care professionals caring for hospitalised infants should be made aware of the potential risks of chloral hydrate as a repetitive dosing sedative, and of the importance of systematically evaluating the appropriateness and effectiveness of utilising such pharmacological intervention for managing and treating distress.

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