Nav: Home

Alternative treatment approach for neonatal abstinence syndrome may shorten hospital stay

May 04, 2017

SAN FRANCISCO, Calif. - New research suggests a revamped, "common sense" approach to treating newborns suffering opioid withdrawal--gauging whether the baby can eat, sleep and be consoled within 10 minutes before administering drugs to wean them off exposure--may safely reduce the length of hospitalization they need.

An abstract of the study, "A Novel Approach to Evaluating and Treating Infants with Neonatal Abstinence Syndrome (NAS)," will be presented at the Pediatric Academic Societies 2017 Meeting in San Francisco on Sunday, May 7.

An estimated 95 percent of U.S. hospitals use the Finnegan Neonatal Abstinence Scoring System (FNASS) to guide treatment, based on 21 symptoms of opioid withdrawal. These include tremors, seizures, excessive crying, diarrhea, vomiting, congestion, sneezing and other symptoms that can make it difficult for the baby to eat and sleep. Babies with severe symptoms are started on pharmacologic therapy, typically using the narcotics morphine or methadone.

Researchers at Yale-New Haven Children's Hospital examined whether more non-pharmacologic interventions for NAS in a modified approach called the Eat, Sleep, Console (ESC) model, such as providing a low-stimulation environment, having mothers room-in with their infants and feeding them frequently, could help infants go home sooner.

Fifty babies were included in the study between March 2014 and August 2015. The researchers determined traditional FNASS guidelines would have indicated starting morphine treatment in 30 (60 percent) of the infants. With the ESC guidelines used instead, however, morphine was started on just 6 patients (12 percent).

The study also found that of the 301 patient days evaluated, the FNASS score recommended starting or increasing morphine therapy on one-quarter of the days. Instead, following the ESC model, morphine was started or increased on just 3 percent of the days.

Using the alternative approach helped reduce the length of hospitalization for infants with NAS from 22.5 to 5.9 days without an increase in readmission rate, said Matthew Grossman, MD, an assistant professor of pediatrics at Yale School of Medicine and Quality and Safety Officer for the hospital who launched the ESC model there in 2011.

Abstract author Matthew Lipshaw, MD, FAAP, said the findings are particularly important with the current opioid epidemic in the United States. The incidence of NAS increased fivefold between 2000-2015 in the United States, Dr. Lipshaw noted, resulting in an estimated $1.5 billion in hospital charges in 2012 alone.

"We found that a common sense approach based on the functional well-being of infants is a safe and more effective way to treat NAS than traditional treatment guidelines, substantially reducing exposure to opioids in these infants and better meeting patient needs," Dr. Lipshaw said.
-end-
Dr. Lipshaw will present the abstract, "A Novel Approach to Evaluating and Treating Infants with Neonatal Abstinence Syndrome," between 10:30 a.m. and 12:30 p.m. on Sunday, May 7, at the Moscone West Convention Center in San Francisco.

Reporters interested in an interview with Dr. Lipshaw may contact him at 231-881-1305 or matthew.lipshaw@yale.edu. To reach Dr. Grossman, contact him at 201-824-8507 or matthew.grossman@yale.edu.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. Contact the researcher for more information.

The Pediatric Academic Societies (PAS) Meeting brings together thousands of individuals united by a common mission: to improve child health and wellbeing worldwide. This international gathering includes pediatric researchers, leaders in academic pediatrics, experts in child health, and practitioners. The PAS Meeting is produced through a partnership of four organizations leading the advancement of pediatric research and child advocacy: Academic Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Society for Pediatric Research. For more information, visit the PAS Meeting online at http://www.pas-meeting.org, follow us on Twitter @PASMeeting and #pasm17, or like us on Facebook.

ABSTRACT

TITLE: A Novel Approach to Evaluating and Treating Infants with Neonatal Abstinence Syndrome

CURRENT CATEGORY: Hospital Medicine

KEYWORDS: Neonatal Abstinence Syndrome, Drug Exposed Neonate, Methadone.

Background: Infants born to mothers who used opioids in pregnancy may develop neonatal abstinence syndrome (NAS), a constellation symptoms associated with opioid withdrawal. Most institutions use the Finnegan Neonatal Abstinence Scoring System (FNASS) to guide treatment.

Objective: At our institution, we developed a novel approach to treating infants with NAS. Instead of the FNASS, management decisions were evaluated using a new approach which relied on 3 factors: eating, sleeping and consolability (ESC). The purpose of this study was to describe our novel approach and to compare this approach to one based on the FNASS.

Design/Methods: We conducted a retrospective study comparing our novel approach vs the FNASS guided approach for the treatment of infants with NAS. The study population included all infants born at >35 weeks' gestation at Yale-New Haven Children's Hospital with a diagnosis of NAS from March 2014-August 2015 who were cared for in both the well newborn nursery and the general inpatient unit. FNASS scores were obtained during the hospitalization but did not guide management. We measured the number of incidences when using the FNASS approach would have led to starting or increasing medication as well as the number of times morphine was actually started or increased using the ESC approach.

Results: We reviewed 50 patients with prenatal exposures to opioids with a total of 301 hospital days. FNASS scores indicated starting morphine in 30 infants (60%). Morphine was actually started on only 6 patients (12%) (p< 0.0001) based on the ESC approach. The FNASS led protocol directed initiating or increasing meds on 24.6% of days compared to 2.7% of days using the ESC approach (p< 0.0001). The FNASS approach directed that morphine was either not started or decreased on 65.8% of days compared with 94.4% of days using the ESC approach (p< 0.0001). There were no readmissions or reported adverse events.

Conclusion(s): The FNASS has been used to guide the management of infants with NAS since its development in the mid-1970s. Despite its wide acceptance, the FNASS has never been validated nor have its widely used score cutoffs been tested. We suggest that non-FNASS based NAS protocols, using novel evaluation and treatment approaches such as our ESC approach, can decrease medication administration and resource utilization for NAS without leading to significant adverse events. Further work is needed to assess long term neurodevelopmental outcomes associated with various evaluation and treatment approaches.

American Academy of Pediatrics

Related Sleep Articles:

Wind turbine noise affects dream sleep and perceived sleep restoration
Wind turbine noise (WTN) influences people's perception of the restorative effects of sleep, and also has a small but significant effect on dream sleep, otherwise known as REM (rapid eye movement) sleep, a study at the University of Gothenburg, Sweden, shows.
To sleep deeply: The brainstem neurons that regulate non-REM sleep
University of Tsukuba researchers identified neurons that promote non-REM sleep in the brainstem in mice.
Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.
'Short sleep' gene prevents memory deficits associated with sleep deprivation
The UCSF scientists who identified the two known human genes that promote 'natural short sleep' -- nightly sleep that lasts just four to six hours but leaves people feeling well-rested -- have now discovered a third, and it's also the first gene that's ever been shown to prevent the memory deficits that normally accompany sleep deprivation.
Short sleep duration and sleep variability blunt weight loss
High sleep variability and short sleep duration are associated with difficulties in losing weight and body fat.
Nurses have an increased risk of sleep disorders and sleep deprivation
According to preliminary results of a new study, there is a high prevalence of insufficient sleep and symptoms of common sleep disorders among medical center nurses.
Common sleep myths compromise good sleep and health
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.
Sleep tight! Researchers identify the beneficial role of sleep
Why do animals sleep? Why do humans 'waste' a third of their lives sleeping?
Does extra sleep on the weekends repay your sleep debt? No, researchers say
Insufficient sleep and untreated sleep disorders put people at increased risk for metabolic problems, including obesity and diabetes.
Kicking, yelling during sleep? Study finds risk factors for violent sleep disorder
Taking antidepressants for depression, having post-traumatic stress disorder or anxiety diagnosed by a doctor are risk factors for a disruptive and sometimes violent sleep disorder called rapid eye movement (REM) sleep behavior disorder, according to a study published in the Dec.
More Sleep News and Sleep Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.