Outpatient Pharmacotherapy for Neonatal Abstinence Syndrome

Maalouf, Faouzi I.; Slaughter, James C.; Dudley, Judith A.; Patrick, Stephen W.

doi:10.1016/j.jpeds.2018.03.048

Cited by 21 publications

(11 citation statements)

References 22 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For infants discharged on outpatient pharmacotherapy, the initial median (IQR) hospital length of stay was shorter (11 vs 23 days; p<0.001), however the length of pharmacological therapy was significant longer in outpatients compared inpatients with 60 (38-92) days vs. 19 (10-31) days; p<0.001) [68]. Infants treated as outpatients had have an increased number of emergency room visits within 6 months of discharge (adjusted odds ratio 1.52, 95% CI 1.06-2.17) when compared with those treated as inpatients alone [67]. In comparison, Rasul et al reported that 83% of 774 infants with confirmed NAS were discharged on medication with a median duration of NAS treatment of 76 (35-120) days [66].…”

Section: Treatment Locationmentioning

confidence: 89%

“…Maalouf et al described their experience in 736 infants with confirmed NAS [65]. Overall, 72% were treated with pharmacotherapy of which approximately one-half (46%) were discharged home on outpatient medications [67]. For infants discharged on outpatient pharmacotherapy, the initial median (IQR) hospital length of stay was shorter (11 vs 23 days; p<0.001), however the length of pharmacological therapy was significant longer in outpatients compared inpatients with 60 (38-92) days vs. 19 (10-31) days; p<0.001) [68].…”

Section: Treatment Locationmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)

Mangat

Schmölzer

Kraft

2019

Seminars in Fetal and Neonatal Medicine

View full text Add to dashboard Cite

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of >8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of initial manifestations, should be first be managed with non-pharmacologic approaches which in turn, should not be considered as the sole alternative to drug therapy, but rather, as the base upon which all patients are treated. Those who continue to have symptoms despite supportive care should be pharmacologically treated, which in the most severe cases, is life-saving.

show abstract

Section: Treatment Locationmentioning

confidence: 89%

Section: Treatment Locationmentioning

confidence: 99%

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)

Mangat

Schmölzer

Kraft

2019

Seminars in Fetal and Neonatal Medicine

View full text Add to dashboard Cite

show abstract

“…86 Infants with opioid exposure are also at risk for adverse outcomes, including hospital readmission. 87,88 Women may have to manage their own medical follow-up needs (eg, obstetrics, addiction medicine), their infant's medical follow-up needs (eg, general pediatrician, pediatric infectious disease, lactation support), and additional services (eg, the Special Supplemental Nutrition Program for Women, Infants, and Children, early intervention, child welfare). The task of coordinating these multiple stakeholders, combined with the risk of adverse postdischarge outcomes (such as readmission), 88 makes formalizing the discharge process for infants with opioid exposure critical.…”

Section: Preparing For Dischargementioning

confidence: 99%

“…In a recent study, of nearly 1000 infants with NOWS enrolled in the Tennessee Medicaid program, infants discharged from the hospital on medications had a shorter median length of hospital stay (11 vs 23 days; P , .001) but longer median lengths of treatment (60 vs 19 days; P , .001). 87 Given the lack of long-term follow-up data, clinicians should avoid outpatient tapers when possible. If outpatient tapers are used, a structured weaning plan with comprehensive follow-up should be implemented to minimize total medication time.…”

Section: Discharge Educationmentioning

confidence: 99%

Neonatal Opioid Withdrawal Syndrome

et al. 2020

Self Cite

View full text Add to dashboard Cite

The opioid crisis has grown to affect pregnant women and infants across the United States, as evidenced by rising rates of opioid use disorder among pregnant women and neonatal opioid withdrawal syndrome among infants. Across the country, pregnant women lack access to evidence-based therapies, including medications for opioid use disorder, and infants with opioid exposure frequently receive variable care. In addition, public systems, such as child welfare and early intervention, are increasingly stretched by increasing numbers of children affected by the crisis. Systematic, enduring, coordinated, and holistic approaches are needed to improve care for the mother-infant dyad. In this statement, we provide an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.

show abstract

“…[3][4][5][6][7][8][9][10] OENs, particularly those diagnosed with NAS, are at risk for immediate postdischarge adverse outcomes, including hospital readmission 11 and emergency department use. 12 Furthermore, these risks may extend beyond the perinatal period because OENs and infants with NAS may be at risk for adverse developmental outcomes. [13][14][15][16][17] The birth hospitalization is an optimal opportunity to connect OENs and their families to postdischarge services that may mitigate adverse outcomes; however, there are no standardized discharge guidelines for this population.…”

mentioning

confidence: 99%

Improving the Discharge Process for Opioid-Exposed Neonates

Crook¹,

Munn²,

Scott³

et al. 2019

Hospital Pediatrics

Self Cite

View full text Add to dashboard Cite

Opioid-exposed neonates (OENs) are a population at risk for postdischarge complications. Our objective was to improve completion of a discharge bundle to connect patients with outpatient resources to mitigate postdischarge risks. METHODS: Team Hope, a hospital-wide initiative to improve the care of OENs, examined the completion of a discharge bundle from September 2017 through February 2019. A complete discharge bundle was defined as referral to a primary care physician, referral to early intervention services, referral to in-home nursing assessment and educational services, referral to the development clinic if diagnosed with neonatal abstinence syndrome, and referral to the gastroenterology or infectious disease clinic if exposed to hepatitis C virus. After obtaining baseline data, simple interventions were employed as education of providers, social workers, and case management; reminder notes in the electronic health record; and biweekly reminders to resident physicians. A statistical process control chart was used to analyze our primary measure, with special cause variation resulting in a shift indicated by 8 consecutive points above or below the mean line. RESULTS: One hundred nineteen OENs were examined with an initial discharge bundle completion of 2.6% preimplementation. Referral to early intervention services and the development clinic were the least successfully completed elements before intervention implementation. After the development of the discharge bundle in July 2018, special cause variation was achieved, resulting in a mean-line shift with 60.3% now having a complete bundle for 83 OENs. CONCLUSIONS: We implemented a standardized discharge bundle that improved our discharge processes for OENs.

show abstract

Outpatient Pharmacotherapy for Neonatal Abstinence Syndrome

Cited by 21 publications

References 22 publications

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)

Neonatal Opioid Withdrawal Syndrome

Improving the Discharge Process for Opioid-Exposed Neonates

Contact Info

Product

Resources

About