title: Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review.
abstract: OBJECTIVE
  Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of intensive care unit (ICU) delirium in the adult population, with studies demonstrating both efficacy and a favorable safety profile. Although there is a potential role for quetiapine in the treatment of pediatric ICU delirium, there has been no systematic reporting to date of safety in this patient population.
  
  
  METHODS
  Pharmacy records were used to identify 55 consecutive pediatric ICU patients who were diagnosed with delirium and received quetiapine. A comprehensive retrospective medical chart review was performed to collect data on demographics, dosing, and side effects.
  
  
  RESULTS
  Fifty patients treated between January 2013 and November 2014 were included, and five patients were excluded from the study. Subjects ranged in age from 2 months to 20 years. Median daily dose was 1.3 mg/kg/day, and median duration of treatment was 12 days. There were three episodes of QTc prolongation that were clinically nonsignificant with no associated dysrhythmia: Two resolved over time without intervention, and one resolved with decrease in quetiapine dosage. There were no episodes of extrapyramidal symptoms or neuroleptic malignant syndrome.
  
  
  CONCLUSIONS
  In this population of critically ill youth, short-term use of quetiapine as treatment for delirium appears to be safe, without serious adverse events. Further research is required to assess efficacy and evaluate for long-term effects. A prospective, randomized, placebo-controlled study of quetiapine in managing pediatric delirium is necessary.
authors.affiliation: 1 Department of Pediatrics, NewYork-Presbyterian Hospital , New York, New York.
authors.forename: Christine
authors.initials: C
authors.lastname: Joyce
authors.affiliation: 2 Department of Pharmacy, NewYork-Presbyterian Hospital , New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Witcher
authors.affiliation: 1 Department of Pediatrics, NewYork-Presbyterian Hospital , New York, New York.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Herrup
authors.affiliation: 3 Department of Pediatrics, Weill Cornell Medical College , New York, New York.
authors.forename: Savneet
authors.initials: S
authors.lastname: Kaur
authors.affiliation: 2 Department of Pharmacy, NewYork-Presbyterian Hospital , New York, New York.
authors.forename: Elena
authors.initials: E
authors.lastname: Mendez-Rico
authors.affiliation: 4 Department of Psychiatry, Weill Cornell Medical College , New York, New York.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Silver
authors.affiliation: 3 Department of Pediatrics, Weill Cornell Medical College , New York, New York.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Greenwald
authors.affiliation: 3 Department of Pediatrics, Weill Cornell Medical College , New York, New York.
authors.forename: Chani
authors.initials: C
authors.lastname: Traube
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003693:Delirium / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D000069348:Quetiapine Fumarate / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate