Protocol-driven Neonatal Abstinence Syndrome care effective

1. Among infants managed for neonatal abstinence syndrome (NAS), strict weaning protocols were associated with significantly shorter opioid treatment duration and hospital stay compared to those treated without strict weaning parameters.

2. Length of hospital stay and treatment duration did not differ significantly between groups of infants treated initially with morphine versus methadone.

Evidence Rating Level: 2 (Good)

Study Rundown: As more infants are born to opioid-dependent mothers, neonatal abstinence syndrome (NAS) is on the rise. NAS is a condition marked by a variety of deficits that include autonomic dysfunction and attention. While many different methods for managing NAS exist, there is no agreement on how best to treat the condition. Researchers conducting the current study aimed to examine variations in NAS management to determine if standardized pharmacologic protocols were associated with better primary outcome measures, namely shorter opioid treatment period and hospital stay. Study findings indicated that infants treated on strict weaning protocols were more likely to have shorter opioid treatment durations and shorter hospital stays. This study was limited by estimation of treatment days for those infants discharged with outpatient narcotic prescriptions and included only infants treated at select neonatology groups in the state of Ohio. However, its large sample size and significant findings indicate that efficient, cost-effective care for infants with NAS may lie in the implementation and monitoring of infants on standardized weaning protocols, regardless of the narcotic initially used.

Click to read the study, published today in Pediatrics

Relevant Reading: Variation in treatment of neonatal abstinence syndrome in US Children’s Hospitals, 2004-2011

Study Author, Eric S. Hall, PhD, talks to 2 Minute Medicine: Assistant Professor, University of Cincinnati Department of Pediatrics.

“Although there remains a lack of consensus regarding the optimal pharmacologic treatment for NAS, this study demonstrates that regardless of treatment opioid, improved outcomes may be achieved through standardizing treatment and weaning guidelines.”

In-Depth [retrospective cohort study]: Files from a total of 547 infants (mean gestational age = 38.3 + 1.6 weeks, 52.8% male) treated with opioids for NAS during January 2012 through July 2013 were reviewed and categorized by adherence to an established opiate weaning protocol (N = 130 not on standardized protocols, N = 417 on strict protocol). Patient files were taken from infants cared for by 6 neonatology groups, representing 20 hospitals in Ohio. Patient care on strict protocols included explicit opioid dosing or weaning strategies. Outcomes, including time to discharge and exact or estimated length of required opioid treatment, were compared between groups using mixed effects models. In addition, secondary analyses examined outcomes of initial treatment of NAS with methadone or morphine among infants treated on established protocols. When compared to infants treated on strict protocols, those on less stringent management plans were treated for a significantly longer time (32.1 days vs. 17.7 days, P < .0001) and had longer hospital stays (32.1 days vs. 22.7 days, P < .004). Among the 6 neonatology groups studied, 3 weaned using morphine and 3 weaned using methadone. No significant differences in length of treatment, hospital stay, or likelihood to require secondary therapy were observed between infants on protocols involving either morphine or methadone; however, those treated on a morphine taper were more likely to have a longer duration of adjuvant phenobarbital therapy.

More from this author: High prevalence of pediatric dosing errors suggests unit standardization; Risk factors for sleep-related death may differ by age; Delayed umbilical cord clamping associated with potential antioxidant effect; Antibiotic GBS prophylaxis linked to decreased early-onset neonatal infection [Pediatrics Classics Series]; Caregiver-mediated autism interventions effective for low-resourced families

Image: PD

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