The Incubator #296 - Understanding Delirium in the NICU
Delirium in the NICU is an under-recognized and under-assessed challenge. In this episode of The Incubator Podcast, Ben and Daphna sit down with Dr. Karishma Rao and clinical pharmacist Alex Oschman from Children’s Mercy Hospital to explore the complexities of neonatal delirium. Drawing on their collaborative work and recent publication in Frontiers in Pharmacology, they unpack the nuances of distinguishing delirium from pain, agitation, withdrawal, and sedation—particularly in medically complex, long-stay infants.
The conversation highlights the limitations of current assessment tools, such as the CAPD (Cornell Assessment of Pediatric Delirium), and the barriers to implementation in the NICU setting. The team shares practical strategies, including modifying pain and withdrawal protocols, minimizing deliriogenic medications like benzodiazepines and opioids, and emphasizing non-pharmacological interventions like early mobility, sleep hygiene, and environmental optimization.
They also discuss pharmacologic options when needed, such as the selective use of atypical antipsychotics like quetiapine or risperidone, and raise critical questions about how developmental care might reduce the need for sedation altogether. This episode is a call to action for NICU teams to better understand, assess, and address delirium in our most vulnerable patients through collaborative, multidisciplinary care.
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.
Enjoy!