# Standard work tools for managing pediatric baclofen pump infections and withdrawal

## TL;DR

This paper introduces standardized tools to manage ITB pump infections and withdrawal in children, aiming to improve safety and consistency in treatment.

## Contribution

The novel contribution is the development of pediatric-specific standard work tools for managing ITB pump complications.

## Key findings

- The SWTs standardize evaluation and treatment protocols for ITB pump infection and withdrawal.
- The tools enabled consistent management across multidisciplinary teams in both emergent and subacute cases.
- Two representative cases demonstrated the effectiveness of the SWTs in real-world clinical scenarios.

## Abstract

Intrathecal baclofen (ITB) pumps are essential for managing spasticity and dystonia in children; however, they carry risks of hardware infection, withdrawal syndrome, and emergent failure. Management of these complications remains variable across institutions, and no unified, pediatric-specific workflow exists to date. We sought to develop and implement standard work tools (SWTs) to guide the evaluation and treatment of ITB pump infection and withdrawal in pediatric patients.

Senior-level pediatric neurosurgery and physical medicine and rehabilitation (PM&R) physicians at a high-volume tertiary children’s hospital (Ann and Robert H. Lurie Children’s Hospital) collaboratively developed two structured SWTs addressing: (1) diagnosis and care of suspected ITB pump infection; and (2) structured weaning protocols to prevent and manage withdrawal during pump explantation or malfunction. SWTs were disseminated through detailed manuals and real-time clinical decision support. Their clinical utility was assessed through implementation in cases requiring pump interrogation or removal.

The SWTs were successfully applied across multidisciplinary teams; collectively, they standardize pump interrogation, laboratory evaluation, drug conversion strategies, ITB dose-based weaning thresholds, and escalation procedures for severe withdrawal or infection. The tools enabled consistent management of both emergent and subacute presentations. We further demonstrate their effectiveness through two representative cases: one involving MSSA pocket infection requiring pump removal and structured withdrawal management, and another involving non-inflammatory wound breakdown with preserved pump function requiring coordinated interdisciplinary care.

SWTs improve safety and timeliness in the management of ITB pump infections and baclofen withdrawal in children. The presented tools provide a reproducible framework for first-line providers and pertinent specialists, particularly for those who may not be familiar with key signs and varied presentations. Broader adoption may reduce variability in treatment while optimizing longitudinal ITB therapy outcomes in pediatric patients.