Abstract
ObjectiveAssess management of neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices.Study designWe fielded an internet-based survey of 37 questions to medical directors or nurse managers at 145 birth hospitals in California.ResultsSeventy-five participants (52%) responded. Most respondents reported having at least one written protocol for managing NAS, but gaps included protocols for pharmacologic management. Newer tools for assessing NAS severity were not commonly used. About half reported usually or always using nonpharmacologic strategies; there is scope for increasing breastfeeding when recommended, skin-to-skin care, and rooming-in.ConclusionsWe found systematic gaps in care for infants with NAS in a sample of California birth hospitals, as well as opportunities to spread best practices. Adoption of new approaches will vary across hospitals. A concerted statewide effort to facilitate such implementation has strong potential to increase access to evidence-based treatment for infants and mothers.
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.University, Stanford, CA, USA 4 California Perinatal Quality Care Collaborative (CPQCC), Stanford University, Stanford, CA, USA 5 Division of Neonatal & Developmental Medicine, StanfordUniversity School of Medicine, Stanford, CA, USA 6 Walnut Creek Medical Center, Kaiser Northern California neonatal abstinence syndrome (NAS)Workgroup Co-chair, Walnut Creek, CA, USA 7 Department of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USANeonatal abstinence syndrome (NAS), called neonatal opioid withdrawal syndrome, is the result of in-utero exposure to opioids
Our findings suggest that newer tools for assessing NAS severity and infant physiologic parameters are not commonly used in California hospitals, despite emerging research and quality-improvement initiatives suggesting that these newer tools may reduce pharmacologic treatment and length of infant hospital stays [18, 33]
Our study found potential gaps in care for infants affected by NAS in a sample of California birth hospitals and opportunities to overcome these gaps, with more than half of study respondents self-identifying strategies to improve care
Summary
University, Stanford, CA, USA 4 California Perinatal Quality Care Collaborative (CPQCC), Stanford University, Stanford, CA, USA 5 Division of Neonatal & Developmental Medicine, Stanford. University School of Medicine, Stanford, CA, USA 6 Walnut Creek Medical Center, Kaiser Northern California NAS. The reported incidence of NAS in California increased from 4.6 to 8.1 incidences of NAS per 1000 live births from the period 2009 to 2012 to the period 2013–2016, and rates varied more than tenfold across counties in both periods [7]. Previous studies have shown hospitals’ approaches to identifying, managing, caring for, and treating opioid-exposed newborns vary widely [9, 10].
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