Measurement of movement is an objective method to assist in assessment of opiate withdrawal in newborns

Abstract

Objective: To develop an objective and reliable method to assess drug withdrawal in newborns by quantitatively estimating the amount of movement rather than scoring individual withdrawal signs. Design: In this cross sectional study, a commercial portable motion detector with computer memory, similar to a wrist watch (the actigraph) was used to measure movement. The measurements were compared with a clinical decision based on the neonatal abstinence syndrome (NAS) score. Movement was analysed, using non-parametric tests, in three groups: a control group of 10 infants, 13 opiate exposed newborns not treated for NAS, and 30 newborns treated for NAS (17 before treatment, eight within 24 hours of treatment, five when stabilised). Results: There were significant differences in the median activity score, expressed as counts per minute (cpm), in the pretreatment group (124 cpm) compared with the control (42 cpm, p , 0.0001), nontreated (74 cpm, p = 0.001), and stabilised treatment (75 cpm, p = 0.007) groups. The accuracy of the actigraph in the identification of newborns requiring treatment from those who did not was high compared with the clinical scores; sensitivity 94%; specificity 85%; positive and negative predictive values 88% and 92% respectively. Conclusions: The measure of movement is comparable to the clinical score in the identification of newborns who require treatment and in determining the severity of withdrawal. The clear advantage of this method is its objectivity, reliability, and efficiency as a simple, non-invasive, bedside measure. Further evaluation in a randomised, controlled trial would establish comparative benefits, potential harms, safety, and acceptability.

Nursing infants with neonatal abstinence syndrome: Time to change practice?

“…Morphine is the most frequently chosen treatment of choice for a neonate with NAS in the UK (Serane and Kurian, 2008;Abrahams et al, 2007;and O'Brien et al, 2004). In a recent study by O'Grady et al (2009), 92% of UK neonatal units stated they used morphine as the first-line treatment strategy.…”

“…O'Brien and Jeffery (2002) and O'Brien et al (2004) suggest simpler alternatives, such as observing the infant's movements and sleep patterns, which, they argue, may be the most reliable determinants of when treatment is required. O'Brien and Jeffery (2002) and O'Brien et al (2004) argue that where a drug-exposed infant has a high movement count, suffers disrupted and fragmented sleep with a large amount of waking time, they are most likely to need pharmacological treatment for withdrawal. O'Brien and Jeffery (2002) and O'Brien et al (2004) also suggest that these simpler observations are suitable for determining when the morphine treatment can be reduced, as indicated by a reduction in motor movement, or improvement in sleeping patterns.…”

“…O'Brien and Jeffery (2002) and O'Brien et al (2004) argue that the Finnegan Scoring System (1975) has several disadvantages in that the process is very time-consuming, it does not monitor the infant constantly, and measurements are highly subjective and therefore liable to inter-observer discrepancy (O'Brien et al, 2004 andJeffery, 2002). O'Brien and Jeffery (2002) and O'Brien et al (2004) suggest simpler alternatives, such as observing the infant's movements and sleep patterns, which, they argue, may be the most reliable determinants of when treatment is required. O'Brien and Jeffery (2002) and O'Brien et al (2004) argue that where a drug-exposed infant has a high movement count, suffers disrupted and fragmented sleep with a large amount of waking time, they are most likely to need pharmacological treatment for withdrawal.…”

“…The Finnegan Scoring System (1975) is widely used in current practice to assess the condition of a newborn with NAS (O'Grady et al, 2009). The tool relies upon discrete nursing observations of the central nervous system, including high-pitched cry, disrupted sleeping and presence of convulsions, the gastrointestinal system, including loose or watery stools, vomiting and reduced feeding, and other systems including pyrexia, yawning, raised respiratory rate and sneezing (O'Brien et al, 2004). O'Brien and Jeffery (2002) and O'Brien et al (2004) argue that the Finnegan Scoring System (1975) has several disadvantages in that the process is very time-consuming, it does not monitor the infant constantly, and measurements are highly subjective and therefore liable to inter-observer discrepancy (O'Brien et al, 2004 andJeffery, 2002).…”

“…The tool relies upon discrete nursing observations of the central nervous system, including high-pitched cry, disrupted sleeping and presence of convulsions, the gastrointestinal system, including loose or watery stools, vomiting and reduced feeding, and other systems including pyrexia, yawning, raised respiratory rate and sneezing (O'Brien et al, 2004). O'Brien and Jeffery (2002) and O'Brien et al (2004) argue that the Finnegan Scoring System (1975) has several disadvantages in that the process is very time-consuming, it does not monitor the infant constantly, and measurements are highly subjective and therefore liable to inter-observer discrepancy (O'Brien et al, 2004 andJeffery, 2002). O'Brien and Jeffery (2002) and O'Brien et al (2004) suggest simpler alternatives, such as observing the infant's movements and sleep patterns, which, they argue, may be the most reliable determinants of when treatment is required.…”