title: Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients.
abstract: OBJECTIVE
  Methadone administration has increased in pediatric clinical settings. This review is an attempt to ascertain an equianalgesic dose ratio for methadone in the pediatric population using standard adult dose conversion guidelines.
  
  
  METHODS
  US tertiary children's hospital.
  
  
  METHODS
  Hospitalized pediatric patients, 0-18 years of age.
  
  
  METHODS
  A retrospective chart review was conducted for patients who were converted from their initial opioid therapy regimen (morphine, hydromorphone, and/or fentanyl) to methadone. The primary endpoint was whether or not a dose correction was needed for methadone in the 6 days following conversion using standard dose conversion charts for adults. Documented clinical signs of withdrawal, unrelieved pain, or oversedation were examined.
  
  
  RESULTS
  The majority (53.7 percent) of the 199 children were converted to methadone on intensive care units prior extubation or postextubation. The mean conversion ratio was 23.7 mg of oral morphine to 1 mg of oral methadone (median, 18.8 mg:1 mg, SD=25.7). Most patients experienced an adequate conversion (n=115, 57.8 percent), while 83 (41.7 percent) appeared undermedicated, and one child was oversedated. There were no associations found with conversion ratios for initial morphine dose, days to conversion, or effect of withdrawal of concomitant agents with potential for withdrawal.
  
  
  CONCLUSIONS
  Opioid conversion to methadone is commonly practiced at our institution; however, dosing was significantly lower compared to adult conversion ratios, and more than 40 percent of children were undermedicated. The majority of children in this study received opioids for sedation while intubated and ventilated; therefore, safe and efficacious pediatric methadone conversion rates remain unclear. Prospective studies are needed.
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fife
authors.affiliation: Scientific Investigator, Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Andrea
authors.initials: A
authors.lastname: Postier
authors.affiliation: Career Scientist, Head of Design and Analytics Core, Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Andrew
authors.initials: A
authors.lastname: Flood
authors.affiliation: Medical Director, Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Associate Professor, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Friedrichsdorf
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003243:Consciousness / Q000187:drug effects; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D062787:Drug Overdose / Q000209:etiology; D057915:Drug Substitution; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D007442:Intubation, Intratracheal; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D008910:Minnesota; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010607:Pharmacy Service, Hospital; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone