Improving Care for Neonates With Abstinence Syndrome

Abstract

Research Article| September 01 2017 Improving Care for Neonates With Abstinence Syndrome AAP Grand Rounds (2017) 38 (3): 28. https://doi.org/10.1542/gr.38-3-28 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Improving Care for Neonates With Abstinence Syndrome. AAP Grand Rounds September 2017; 38 (3): 28. https://doi.org/10.1542/gr.38-3-28 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: morphine, neonatal abstinence syndrome, opioids, patient readmission, seizures, transfer technique, sleep, neonatal intensive care units, inpatients Source: Grossman MR, Berkwitt AK, Osborn RR, et al. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics. 2017; 39(6): e20163360; doi: https://doi.org/10.1542/peds.2016-3360Google Scholar Investigators from Yale University conducted a study to assess the effectiveness of an initiative designed to decrease length of stay (LOS) in newborns treated for neonatal abstinence syndrome (NAS) at Yale New Haven Children’s Hospital (YNHCH). In the pre-intervention period of 2008–2010, newborns at risk for NAS were admitted to the NICU. Signs of NAS were assessed by using the Finnegan Neonatal Abstinence Scoring System (FNASS). On the basis of FNASS scores, oral morphine was administered every 3 hours; morphine doses were decreased by ≤10% every 24–48 hours, if possible. Over a 5-year period, a multidisciplinary team developed interventions designed to reduce LOS in newborns with NAS. Interventions were assessed by using plan-do-study-act methodology. Ultimately, the initiative focused on several interventions, including maximizing the use of nonpharmacological interventions, effectively engaging parents in the care of their children, discontinuing the use of FNASS and instead developing a simplified assessment of newborn symptoms, decreasing the use of morphine, and admitting newborns with NAS to inpatient units that allowed parents to room in. With the revised assessment system, neonates who could breastfeed effectively or take ≥1 oz from a bottle, sleep for ≥1 hour, and, if crying, be consoled within 10 minutes were not given morphine. Morphine (0.05 mg/kg) was administered on an as-needed basis to newborns not meeting these criteria. To assess the effectiveness of the initiative, outcomes in neonates treated for NAS at YNHCH during the pre-intervention period and those treated for NAS after the interventions were implemented (May 2015 to June 2016) were compared. Outcomes evaluated included LOS, need for morphine treatment, and hospital costs. Balancing measures assessed were need for transfer to a NICU, seizures, and hospital readmission. Data on 55 newborns born during the baseline period and 44 in the postimplementation period were analyzed. Mean LOS was 22.4 days for those treated in the baseline period and 5.9 days in the postimplementation period (74% reduction, P < .001). The percentage of neonates requiring morphine treatment decreased from 98% to 14% between the pre- and postimplementation periods (P <.001), and mean hospital costs decreased from $44,824 to $10,289 (P < .001). There were no seizures reported in any patient and no readmissions, and no newborn admitted to an inpatient unit required transfer to a NICU. The authors conclude that the initiative to improve care for newborns with NAS led to a substantial reduction in LOS. Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Although this was a relatively small, single-site study, it demonstrates a remarkable quality-improvement measure for multiple reasons. It represents a new approach to an old problem, that of NAS—the constellation of neuromuscular and gastrointestinal... You do not currently have access to this content.