Neonatal Abstinence Syndrome and the Pediatric Hospitalist: 5 Years Later.

Abstract

As the US opioid crisis grows, neonatal abstinence syndrome (NAS) is increasingly common in inpatient settings, from community-hospital nurseries to inpatient units and NICUs at large children’s hospitals. NAS is stressing perinatal care systems because of lengthy and costly hospital stays and is garnering attention not only in health care but also in public policy circles and the media.1 Commensurate with the dramatic increase in NAS cases, in some settings, the management of NAS is shifting from neonatology to pediatric hospital medicine. This represents a unique opportunity. In this issue of Hospital Pediatrics , Milliren et al2 report significant variability in NAS care practices across US hospitals, including rates of pharmacotherapy use, choice of treatment medication, length of treatment, and length of stay. These inconsistencies exist despite the majority of US hospitals using some form of the Finnegan Neonatal Abstinence Scoring System (FNASS) to assess infants with NAS. This is less surprising when one considers that neither the tool (which was created in 1975) nor the protocols developed for its clinical application have ever been rigorously validated.3 As Milliren et al2 find, treatment with pharmacologic agents is associated with higher costs and longer lengths of stay. Because rates of medication use for symptom management vary by hospital from 13% to …