838: The effect of standardizing treatment when managing neonatal abstinence syndrome

Abstract

Opiate addiction is epidemic in Appalachia resulting in a large increase in the number of newborns requiring treatment for neonatal abstinence syndrome (NAS). The American Academy of Pediatrics currently recommends standardization of treatment of NAS; however, prospective studies are lacking regarding the success of this approach. The study purpose was to evaluate overall newborn response and length of stay (LOS) of neonates treated for NAS following the institution of a strict standardized treatment protocol. A prospective cohort study collecting neonatal response to NAS treatment and length of stay comparing newborn outcomes prior to strict morphine protocol standardization to those following the implementation of the standardized treatment protocol. For 30 months, (January 1, 2014 through June 30, 2016) 395 neonates were treated for NAS at our institution. A protocol for NAS management with strict criteria for morphine weaning was fully instituted in June 2015. The response to treatment and LOS for the 17 months prior to the initiation of this protocol was 23.31 (+/- 6.2) days (233 neonates). The response and LOS in the 13 months after protocol initiation was 18.17 (+/- 5.1) days (162 neonates). This was a difference of 5.14 days (95% CI 4.0 to 6.3 days) less in LOS and was highly significant (p < .0001). These prospective data verify that the initiation of a standardized NAS treatment protocol can significantly improve neonatal response and decrease LOS. In Tennessee, the average “payment” (confirmed by the State Medicaid Program) for 1 day in the NICU is a minimum $2,500.00, which amounts to a minimum cost effective savings of $12,500.00 per NAS treated newborn (5 fewer days). In Tennessee alone approximately 1000 NAS cases occur annually, which would amount to a cost effective savings of more than $12.5 million annually in our state alone. It is recommended that institutions with nurseries that treat infants with NAS develop standardized treatment protocols to cost effectively improve care for this complicated patient population.