NEW YORK (Reuters Health) – Statewide implementation of a standardized protocol to treat neonatal abstinence syndrome (NAS) in Ohio neonatal ICUs appears to have reduced the duration of opioid exposure as well as the length of hospital stay in opioid-exposed newborns.
“The ability to spread a complex protocol across 54 hospitals statewide is a testament to the urgency of the opioid epidemic as well as to the power of rigorous quality improvement (QI) science and collaborative work,” researchers with the Ohio Perinatal Quality Collaborative write in Pediatrics, online March 7.
NAS has increased significantly in the U.S. and no treatment standards exist, leading to marked variation in management, Dr. Michele Walsh, from Rainbow Babies & Children’s Hospital in Cleveland and colleagues note in their article.
They developed a standardized protocol for pharmacologic and nonpharmacologic care of infants with NAS. The pharmacologic protocol includes standardized guidelines for scoring NAS, triggers for initiation of treatment and a stringent weaning protocol. The non-drug care bundle emphasizes compassionate trauma-informed care for the mother and infant and keeping mother and infant together (swaddling/kangaroo care, feeding on demand, etc.).
In Ohio NICUs between January 2014 and June 2015, compliance with the nonpharmacologic bundle improved from 37% to 59%, and the pharmacologic bundle improved from 59% to 68%.
Among 3,266 opioid-exposed infants, 48% received pharmacologic treatment for NAS symptoms, and this rate did not change much across the study period.Regardless of the opioid used to manage NAS, the length of treatment decreased from 13.4 to 12.0 days and the length of stay decreased from 18.3 to 17 days.
“Although the 1.3-day, 9% reduction in both measures is smaller than the 20% effect desired as the aim of the collaborative, it was both statistically significant and clinically important, given the large number of infants who experienced NAS: an overall reduction of 2,041 hospital days,” the researchers write.
The researchers say other states and institutions treating opioid-exposed infants may benefit from considering this pharmacologic and nonpharmacologic care model for NAS.
Dr. Walsh did not respond to a request for comment by press time.
SOURCE: http://bit.ly/2IaUxla
Pediatrics 2018.
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