Oral Morphine Weaning for Neonatal Abstinence Syndrome at Home Compared with In-Hospital: An Observational Cohort Study

Kelly, Lauren; Knoppert, David; Roukema, Henry; Rieder, Michael J.; Koren, Gideon

doi:10.1007/s40272-014-0096-y

Cited by 30 publications

(38 citation statements)

References 17 publications

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“…This finding is consistent with previous reports that a shorter length of inpatient stay may be achieved with a longer course of opioid treatment. 20 The extended treatment duration is a consequence of a less aggressive home versus inpatient weaning schedule. Still, implementation of stringent weaning guidelines at the site led to a significant, nearly 1-week reduction in treatment duration (26.3 days vs 32.9 days, P = .04).…”

Section: Discussionmentioning

confidence: 99%

“…The long-term implications of prolonged opioid treatment on neurocognitive development are not well understood, and appropriate safeguards and transition models must be implemented before the administration of opioid weans with limited clinical supervision. [20][21][22][23] Concerns about providing morphine or methadone to opiate-addicted parents may be unfounded because the average infant dose is reportedly ,0.2% of the average maternal dose. 21 Nevertheless, social work assessment may aid in the selection of appropriate candidate families to receive treatment in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

et al. 2015

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, on behalf of the OCHNAS Consortium abstract OBJECTIVES: To evaluate the generalizability of stringent protocol-driven weaning in improving total duration of opioid treatment and length of inpatient hospital stay after treatment of neonatal abstinence syndrome (NAS). METHODS:We conducted a retrospective cohort analysis of 981 infants who completed pharmacologic treatment of NAS with methadone or morphine from January 2012 through August 2014. Before July 2013, 3 of 6 neonatology provider groups (representing Ohio's 6 children's hospitals) directed NAS nursery care by using group-specific treatment protocols containing explicit weaning guidelines. In July 2013, a standardized weaning protocol was adopted by all 6 groups. Statistical analysis was performed to identify effects of adoption of the multicenter weaning protocol on total duration of opioid treatment and length of hospital stay at the protocol-adopting sites and at the sites with preexisting protocol-driven weaning.RESULTS: After adoption of the multicenter protocol, infants treated by the 3 groups previously without stringent weaning guidelines experienced shorter duration of opioid treatment (23.0 vs 34.0 days, P , .001) and length of inpatient hospital stay (23.7 vs 31.6 days, P , .001). Protocol-adopting sites also experienced a lower rate of adjunctive drug therapy (5% vs 21%, P = .004). Outcomes were sustained by the 3 groups who initially had specific weaning guidelines after multicenter adoption (duration of treatment = 17.0 days and length of hospital stay = 23.3 days).CONCLUSIONS: Adoption of a stringent weaning protocol resulted in improved NAS outcomes, demonstrating generalizability of the protocol-driven weaning approach. Opportunity remains for additional protocol refinement.WHAT'S KNOWN ON THIS SUBJECT: Use of a standard treatment protocol with stringent weaning guidelines for infants with neonatal abstinence syndrome supports improved outcomes including shorter duration of opioid exposure and length of hospital stay. WHAT THIS STUDY ADDS:We demonstrate generalizability of a protocol-driven weaning strategy for improvement in hospital outcomes for neonatal abstinence syndrome. After adoption, adherent protocol-adopting centers improved outcomes and eliminated differences in outcomes compared with centers with preexisting stringent weaning protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

et al. 2015

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“…10–14 Some have found benefit of home management once infants are stable. 15,16 Furthermore, recent studies have also shown that standardized protocols for NAS management are associated with shorter lengths of stay and decreased hospital costs. 17,18 …”

Section: Introductionmentioning

confidence: 99%

Wide Variation Found in Care of Opioid-Exposed Newborns

Bogen

Whalen

Kair

et al. 2017

Academic Pediatrics

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Background Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. Aim Identify practice variations for newborns with in-utero chronic opioid exposure among hospitals in the Better Outcomes through Research for Newborns (BORN) network. Methods Nursery site leaders completed a survey about hospitals’ policies and practices regarding care for infants with chronic opioid exposure (≥3 weeks). Results The 76/95 (80%) respondent hospitals were in 34 states, varied in size (<500–>8000 births and <10–>200 opioid-exposed infants/year), with most affiliated with academic centers (89%). Most (85%) had protocols for newborn drug exposure screening; 95% used risk-based approaches. Specimens included urine (81%), meconium (73%) and umbilical cords (10%). Of sites (88%) with NAS management protocols, 77% addressed medical management, 72% nursing care, 72% pharmacologic treatment and 58% supportive care. Morphine was the most common first-line pharmacotherapy followed by methadone. Observation periods for opioid-exposed newborns varied; 57% observed short-acting opioid exposure for 2–3 days while 30% observed for ≥5 days. For long-acting opioids, 71% observed for 4–5 days, 19% for 2–3 days and 8% for ≥7 days. Observation for NAS occurred mostly in Level 1 nurseries (86%); however most (84%) transferred to NICUs when pharmacologic treatment was indicated. Conclusion Most BORN hospitals had protocols for the care of opioid-exposed infants, but policies varied widely and characterize areas of needed research. Identification of variation is the first step toward establishing best practice standards to improve care for this rapidly growing population.

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“…However, a combined inpatient/outpatient treatment approach can reduce the total length of stay by ~50% compared to inpatient only, but is associated with significantly longer lengths of treatment. 28,42,56 Methadone is the most commonly employed agent due to a longer half-life, though phenobarbital and morphine have been used. It should be noted that these findings are all based upon retrospective reviews and not randomized, prospective investigations.…”

Section: Outpatient Treatmentmentioning

confidence: 99%

“…Although reports of small numbers of infants suggest the practice is safe, sudden infant death attributed to bed sharing and unsafe sleep practice has been recently reported in a cohort of infants weaned at home using morphine. 56 …”

Section: Outpatient Treatmentmentioning

confidence: 99%

Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant

Kraft

Stover

Davis

2016

Seminars in Perinatology

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Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for “personalized genomic medicine” and novel, individualized therapeutic interventions.

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Oral Morphine Weaning for Neonatal Abstinence Syndrome at Home Compared with In-Hospital: An Observational Cohort Study

Cited by 30 publications

References 17 publications

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

Wide Variation Found in Care of Opioid-Exposed Newborns

Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant

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