Pharmacologic Management of Neonatal Abstinence Syndrome in a Community Hospital

Napolitano, Anthony; Theophilopoulos, Dean; Seng, Sara K.; Calhoun, Darlene A

doi:10.1097/grf.0b013e31827adf91

Cited by 19 publications

(16 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to the Centers for Disease Control and Prevention (CDC), the incidence of NAS increased 3‐fold in the United States from 1999 to 2013 . Previous studies have shown that the incidence of NAS in Florida increased disproportionally by >10‐fold during a similar period . Identifying the underlying factors associated with this increase is important for prioritizing strategies for NAS prevention, especially in Florida.…”

Section: Introductionmentioning

confidence: 99%

Trends of Neonatal Abstinence Syndrome Epidemic and Maternal Risk Factors in Florida

et al. 2017

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Trends of Neonatal Abstinence Syndrome Epidemic and Maternal Risk Factors in Florida

et al. 2017

View full text Add to dashboard Cite

show abstract

“…18 In a study from Florida, the number of neonates who had NAS and were admitted to the NICU increased by 10-fold from 2005 to 2011. 21 Increases in the incidence of NAS have been reported uniformly across community hospitals, teaching hospitals, and children' s hospitals. 22 All communities and all ethnicities have been affected.…”

Section: Incidencementioning

confidence: 99%

“…49 Morphine dose can also be escalated by .10% for higher scores. 21 Methadone can be substituted for morphine for opioid withdrawal. Cardiopulmonary monitoring of the infant is preferred during the acute stage.…”

Section: Figurementioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

View full text Add to dashboard Cite

Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

show abstract

“…17, 18 Others, however, have abandoned outpatient management because of concerns raised by community pediatricians regarding NAS management. 19 …”

Section: Discussionmentioning

confidence: 99%

A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic

et al. 2017

View full text Add to dashboard Cite

Objective:The purpose of this study was to test a specialized needs-based management model for a high volume of babies born with neonatal abstinence syndrome (NAS) while controlling costs and reducing neonatal intensive care unit (NICU) bed usage.Study Design:Data were analyzed from inborn neonates >35 weeks’ gestational age with the diagnosis of NAS (ICD9-CM 779.5), requiring pharmacologic treatment and discharged from 2010 through 2015. Significance was determined using Kruskal–Wallis and Mann–Whitney as well as χ2 for trend.Results:NAS requiring medication treatment increased from 34.1 per 1000 live births in 2010 to 94.3 per 1000 live births in 2015 (P<0.0001 for trend). Hospital charges were significantly different in the three described locations (P<0.0001). Median per patient hospital charges for medically treated NAS were $90 601 (interquartile range (IQR) $64 489 to $128 135) for NAS patients managed in the NICU, $68 750 (IQR $44 952 to $92 548) for those managed in an in-hospital dedicated unit and $17 688 (IQR $9933 to $20 033) for those cared for in an outpatient neonatal withdrawal center. NICU admission was avoided in 78% of the population once both alternative locations were fully implemented.Conclusions:In this cohort of infants, a 219% increase in the number of infants treated for NAS overwhelmed the capacity of our traditional resources. There was a need to develop new treatment approaches dealing with the NAS crisis and a growing population of prenatally exposed babies. We found that the described model of care significantly reduced charges and stabilized admissions to our NICU despite the marked increase in cases. Without this system, our NICU would be in a critical state of gridlock and diversion; instead, we have efficient management of a large NAS population.

show abstract

Pharmacologic Management of Neonatal Abstinence Syndrome in a Community Hospital

Cited by 19 publications

References 8 publications

Trends of Neonatal Abstinence Syndrome Epidemic and Maternal Risk Factors in Florida

Trends of Neonatal Abstinence Syndrome Epidemic and Maternal Risk Factors in Florida

Neonatal Abstinence Syndrome

A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic

Contact Info

Product

Resources

About