An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome

Grossman, Matthew; Berkwitt, Adam; Osborn, Rachel; Xu, Yanyi; Esserman, Denise; Shapiro, Eugene D.; Bizzarro, Matthew J.

doi:10.1542/peds.2016-3360

Cited by 200 publications

(307 citation statements)

References 13 publications

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“…25 Recent studies suggest that simple, function-based assessments, such as the Eat, Sleep, Console (ESC) approach developed by Grossman and colleagues, may serve as an alternative to the FNASS for evaluating withdrawal. 26,27 With ESC, the need for pharmacotherapy is evaluated by the newborn's ability to (1) eat (breastfeed successfully or eat at least 1oz per feed), (2) sleep uninterrupted for at least one hour, and (3) be consoled within 10 minutes. To date, research on the implementation of ESC has primarily focused on reducing length of stay and need for pharmacologic treatment in the context of quality improvement initiatives.…”

Section: Monitoring and Evaluationmentioning

confidence: 99%

“…To date, research on the implementation of ESC has primarily focused on reducing length of stay and need for pharmacologic treatment in the context of quality improvement initiatives. 26,27 Further prospective studies are warranted that compare ESC to traditional approaches involving the FNASS, and that evaluate post-discharge outcomes including newborn weight gain, ongoing withdrawal symptoms at home, and readmission.…”

Section: Monitoring and Evaluationmentioning

confidence: 99%

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Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

Goyal

McAllister

2020

Journal of Hospital Medicine

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In the past two decades, the incidence of neonatal abstinence syndrome (NAS) has risen fivefold, mirroring the rise of opioid use disorder (OUD) among pregnant women. The resulting increases in length of stay and neonatal intensive care utilization are associated with higher hospital costs, particularly among Medicaid-financed deliveries. Pregnant women with OUD require comprehensive medical and psychosocial evaluation and management; this combined with medication-assisted treatment is critical to optimize maternal and newborn outcomes. Multidisciplinary collaboration and standardized approaches to screening for intrauterine opioid exposure, evaluation and treatment of NAS, and discharge planning are important for clinical outcomes and may improve maternal experience of care.

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Section: Monitoring and Evaluationmentioning

confidence: 99%

Section: Monitoring and Evaluationmentioning

confidence: 99%

Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

Goyal

McAllister

2020

Journal of Hospital Medicine

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“…Notably, the tool has not been validated to show utility in improving outcomes for infants with NAS (6). In an alternative approach that focused on a small number of clinically relevant factors, Grossman et al (23)** describe novel criteria for the clinical assessment of infants with NAS, developed as part of a single center quality improvement project to improve care of substance exposed infants. This functional assessment used 3 parameters: the infant's ability to eat, to sleep, and to be consoled.…”

Section: Identification Of Nas: What Tool To Use?mentioning

confidence: 99%

Neonatal abstinence syndrome: an update

Sanlorenzo

Stark

Patrick

2018

Current Opinion in Pediatrics

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Purpose of review This review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to treat NAS, and the emerging role of quality improvement work in the field of NAS. Recent Findings The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms modified NAS expression and severity. Several centers have explored the use of new bedside assessments, focused on fewer factors to identify infants with NAS, that resulted in a decreased proportion of infants receiving pharmacotherapy for NAS. In addition, buprenorphine was shown to be a promising therapeutic alternative to morphine for treatment of NAS. Lastly, local, state and national quality improvement initiatives aimed to improve outcomes for infants with NAS emerged as an effective manner to advance the care of infants with NAS. Summary NAS remains a critical public health issue associated with significant medical, economic and personal burden. Emerging data on drivers of disease, assessment of withdrawal and treatment for NAS provide clinicians and hospitals with new knowledge and an urgency to promote standardization of care for infants with NAS.

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“…Studies suggest decreased use of pharmacologic treatment and decreased length of birth hospitalizations are associated with written protocols [16,17]; infant physiologic measures to assess NAS; [18] promotion of maternalinfant bonding interventions such as breastfeeding [19,20], "rooming-in" (keeping the mother with the infant during the birth hospitalization) [21], and decreased use of the neonatal intensive care unit (NICU) [22]. These new initiatives have been linked to reductions in hospital cost [23,24]. As the number of opioid-exposed infants has grown in California, so has the urgency of implementing, testing, and promoting new practices and standardization of care for infants with NAS [18,23,25,26].…”

Section: Introductionmentioning

confidence: 99%

Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey

et al. 2020

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Objective Assess management of neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices. Study design We fielded an internet-based survey of 37 questions to medical directors or nurse managers at 145 birth hospitals in California. Results Seventy-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. Conclusions We 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.

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An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome

Abstract: Interventions focused on nonpharmacologic therapies and a simplified approach to assessment for infants exposed to methadone in utero led to both substantial and sustained decreases in ALOS, the proportion of infants treated with morphine, and hospital costs with no adverse events.

Cited by 200 publications

References 13 publications

Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

Neonatal abstinence syndrome: an update

Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey

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