Danielle Cilano, PGY1

Phoenix Children's Hospital, Phoenix, Arizona

Objectives: 

1. Review current pediatric literature on the use of ECG monitoring with methadone administration.
2. Assess the relationship between methadone and QTc prolongation in pediatric patients.
3. Evaluate the impact of methadone on QTc prolongation in pediatric patients to determine the necessity of ECG monitoring.

Abstract:

Introduction: Pediatric literature gives minimal guidance on the necessity of obtaining electrocardiogram (ECG) measurements while on methadone therapy. Methadone is associated with QTc prolongation, which is associated with an increased risk of a potentially fatal arrhythmia, torsades de pointes. We hypothesize that the initiation of methadone will have minimal impact on QTc interval prolongation in pediatric patients, and therefore will not warrant ECG monitoring. The purpose of this study was to determine the utility of ECG monitoring at baseline and during methadone therapy in hospitalized pediatric patients.

Methods: This retrospective chart review included pediatric patients less than 19 years old who received one ECG at baseline and at least one ECG during intravenous and/or enteral methadone therapy while admitted at Phoenix Children's Hospital between 1/1/2014 to 8/1/2018. Exclusion criteria included patients maintained on methadone prior to inpatient admission. Demographics, methadone dose, QTc interval (at baseline and after initiation), concomitant medications (QTc prolonging or CYP-interacting) while on methadone were collected. The primary objective was to evaluate the change in the QTc interval between baseline and during methadone therapy. The secondary objective was to determine the correlation between methadone dose and QTc interval prolongation. Using the sample mean, the 95% confidence interval with a significance level of 0.05 was used to analyze the primary objective. Utilizing a Pearson correlation test, a sample size of 180 patients was needed to provide a 80% power to detect a difference in the QTc interval between baseline and post-methadone initiation.

Results: Results will be submitted within the final slides.
Conclusions: Conclusions will be submitted within the final slides.

Handout Slides:

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