Pulmonary Problems Encountered by the Infant of the Drug-Dependent Mother

Finnegan, Loretta P.

doi:10.1016/s0272-5231(21)00084-8

Cited by 17 publications

(13 citation statements)

References 31 publications

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“…The FNAS remains the most used tool, although it has not been subject to rigorous comparative study, and questions remain regarding its validity. 15,[18][19][20][21][22][23][24][25][26][27] Recently, a quality improvement team developed the Eat, Sleep, Console tool, and its implementation has been associated with decreased LOS and reduced opiate exposure. However, whether these benefits were attributable to the tool or other QI processes remains unclear.…”

Section: Available Knowledgementioning

confidence: 99%

Quality Improvement Targeting Non-pharmacologic Care and As-needed Morphine Improves Outcomes in Neonatal Abstinence Syndrome

McMorrow

Byrnes

Gates

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Despite the rising incidence of neonatal abstinence syndrome (NAS), there remains wide practice variation in its management. Many recent studies have focused on implementing new symptom scoring systems, typically as part of larger improvement interventions. Despite the continued use of the Finnegan Scoring System, we performed a quality improvement project to reduce the day of life at discharge and cumulative opioid exposure for newborns with NAS. Methods: We developed a protocol for NAS treatment emphasizing early transfer to general pediatric units, maximization of non-pharmacologic care, and use of as-needed morphine whenever pharmacologic treatment is required. Outcome metrics were the day of life at discharge and cumulative morphine exposure. As a process measure, we also monitored the day of life at transfer to general pediatric units. In addition, we utilized statistical process control charts to track changes in performance. Results: Twenty-eight patients met the inclusion criteria for analysis over 24 months following project initiation. Day of life at discharge decreased by 61% (20.0 versus 7.89 days, P < 0.001), and cumulative morphine exposure decreased by 81% (13.66 versus 2.57 mg morphine, P ≤ 0.001). Day of life at transfer to general pediatric units decreased by 49% (11.13 versus 5.7 days, P = 0.002). There were no readmissions or other identified adverse events. Conclusions: We achieved significant improvements in NAS outcomes using improved non-pharmacologic care and as-needed morphine. Moreover, the improvement did not require transitioning to a new scoring system. These results support the efficacy and safety of as-needed morphine for NAS management.

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Section: Available Knowledgementioning

confidence: 99%

Quality Improvement Targeting Non-pharmacologic Care and As-needed Morphine Improves Outcomes in Neonatal Abstinence Syndrome

McMorrow

Byrnes

Gates

et al. 2022

Pediatric Quality &Amp; Safety

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“…[11][12][13][14][15][16][17] Observer-rated scales have been used for more than 40 years to assess the severity of NAS and guide the initiation and adjustment of pharmacologic therapy. [18][19][20][21] Differences between raters in the assessment of NAS have been associated with significant differences in initiation and duration of pharmacologic therapy, length of hospital stay, and health care utilization. 22 The Finnegan Neonatal Abstinence Scoring Tool (FNAST) is commonly used for the assessment of neonates with NAS.…”

Section: Introductionmentioning

confidence: 99%

“…[23][24][25] It is a screening tool that comprises 21 items, with many items having 2 to 4 subcategories and weighting for each category, which varies from 1 to 5. 18,19 Although differences among raters have been observed with the use of the FNAST, 26,27 these rater differences can be minimized with a comprehensive educational approach that optimizes and then maintains interobserver reliability. 22,[26][27][28][29] Several tools have been developed to shorten and simplify the FNAST, 27,[30][31][32][33] but existing studies are limited by small cohorts that lack generalizability, study samples that do not differentiate between neonates with and without pharmacologic treatment, and a lack of external validation of the findings.…”

Section: Introductionmentioning

confidence: 99%

“…The Finnegan Neonatal Abstinence Scoring Tool (FNAST) is commonly used for the assessment of neonates with NAS . It is a screening tool that comprises 21 items, with many items having 2 to 4 subcategories and weighting for each category, which varies from 1 to 5 . Although differences among raters have been observed with the use of the FNAST, these rater differences can be minimized with a comprehensive educational approach that optimizes and then maintains interobserver reliability .…”

Section: Introductionmentioning

confidence: 99%

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Association of a Simplified Finnegan Neonatal Abstinence Scoring Tool With the Need for Pharmacologic Treatment for Neonatal Abstinence Syndrome

et al. 2020

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IMPORTANCE Observer-rated scales, such as the Finnegan Neonatal Abstinence Scoring Tool (FNAST), are used to quantify the severity of neonatal abstinence syndrome (NAS) and guide pharmacologic therapy. The FNAST, a comprehensive 21-item assessment tool, was developed for research and subsequently integrated into clinical practice; a simpler tool, designed to account for clinically meaningful outcomes, is urgently needed to standardize assessment. OBJECTIVES To identify FNAST items independently associated with the decision to use pharmacologic therapy and to simplify the FNAST while minimizing loss of information for the treatment decision. DESIGN, SETTING, AND PARTICIPANTS This multisite cohort study included 424 neonates with opioid exposure who had a gestational age of at least 36 weeks with follow-up from birth to hospital discharge in the derivation cohort and 109 neonates with opioid exposure from the Maternal Opioid Treatment: Human Experimental Research Study in the validation cohort. Neonates in the derivation cohort were included in a medical record review at the Universities of Louisville and Kentucky or in a randomized clinical trial and observational study conducted at Tufts University (2014-2018); the

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“…Despite this increase, a standard clinical definition for NAS has been lacking for more than 45 years. Even though NAS has been described as a constellation of clinical signs of withdrawal that can result from prenatal exposure to opioids and other psychotropic substances, an agreed-upon definition has not been established. Accordingly, there has not been consensus on the precise signs of withdrawal or how to diagnose NAS at the bedside.…”

mentioning

confidence: 99%

Implementation of a Standardized Clinical Definition of Opioid Withdrawal in the Neonate

Jilani

Jones

Davis

2022

JAMA

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Pulmonary Problems Encountered by the Infant of the Drug-Dependent Mother

Cited by 17 publications

References 31 publications

Quality Improvement Targeting Non-pharmacologic Care and As-needed Morphine Improves Outcomes in Neonatal Abstinence Syndrome

Quality Improvement Targeting Non-pharmacologic Care and As-needed Morphine Improves Outcomes in Neonatal Abstinence Syndrome

Association of a Simplified Finnegan Neonatal Abstinence Scoring Tool With the Need for Pharmacologic Treatment for Neonatal Abstinence Syndrome

Implementation of a Standardized Clinical Definition of Opioid Withdrawal in the Neonate

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