Nav: Home

Symptom-triggered medication for neonatal opioid withdrawal yields shorter hospital stays

July 09, 2019

BOSTON - A study led by researchers at Boston Medical Center (BMC) found that symptom-triggered medication dosing for neonatal opioid withdrawal syndrome instead of infants receiving a fixed schedule of medication with a long taper reduced the length of their hospital stay. The findings, published in Hospital Pediatrics, indicate that following the novel symptom-triggered approach - developed at BMC - for administering medication could be a more effective intervention for these infants and could help reduce unnecessary medication exposure.

Neonatal Opioid Withdrawal Syndrome (NOWS) effects infants exposed to opioids in utero. With the increase in both unprescribed and prescribed opioids use in the U.S., which has not spared pregnant women, there has been a five-fold increase in the rate of NOWS over the past decade. Approximately 50 to 80 percent of opioid-exposed infants require medication to manage their symptoms of withdrawal, which usually appear two to three days after birth and can include irritability, trouble eating and sleeping, diarrhea, muscle rigidity, and difficulty soothing. Medications that are currently used to manage these symptoms include methadone, morphine, and buprenorphine. The average hospital stay for infants with NOWS who are treated with medication is 23 days and costs approximately $93,000.

During the postpartum hospitalization, all infants with NOWS are assessed based on their ability to eat, sleep and be consoled every four hours. At BMC, clinicians utilize non-pharmacologic care interventions, including parental presence at the bedside, breastfeeding, and rooming in, as first line treatment of NOWS, which studies have shown to reduce the need for medication and hospital length of stay, thus reducing costs. If an infant is having difficulties with these core functions after using the non-pharmacologic treatments, the health care team determines if medication is the appropriate next step.

In this study, for infants who required medication for NOWS, the researchers investigated two treatment approaches: between June 2016 and November 2017, the fixed schedule medication approach was used, in which methadone was dosed every eight hours with the traditional slow taper to treat NOWS. Between December 2017 and May 2018, the researchers implemented the symptom-triggered approach, which was developed by clinician researchers at BMC as a novel way to treat NOWS by focusing on treating symptoms and keeping the infants comfortable. This approach helps reduce the incidence of creating a dependence on the opioid medication, which can sometimes occur with the traditional fixed scheduled medication approach.

Infants who were treated using the symptom triggered approach had a median length of stay of 10.5 days, versus 17 days for the fixed schedule approach. The symptom triggered group had 5.6 fewer days of methadone treatment compared to the fixed-medication schedule group. In addition, the percentage of infants who were successfully treated using the symptom-triggered approach reached 100 percent by the end of the study period, and there were no adverse events resulting from this treatment approach.

"Our study showed that treating symptoms acutely with medication, and not having a fixed schedule with a long taper not only improves patient outcomes, but shortens their hospitalizations and decreases further exposure to opioid medications," said Elisha Wachman, MD, the study's corresponding author who is a neonatologist at BMC and an associate professor of pediatrics at Boston University School of Medicine. "This novel approach prioritizes the non-pharmacologic care approach for infants experiencing withdrawal symptoms and decreases the risk for unintended dependence that frequently occurs when infants are placed on prolonged methadone or morphine tapers."
-end-
The study was funded in part by the Massachusetts Health Policy Commission Neonatal Abstinence Syndrome Innovation Grant.

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $116 million in sponsored research funding in fiscal year 2017. It is the 15th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.

Boston Medical Center

Related Infants Articles:

Deaf infants' gaze behavior more advanced than that of hearing infants
Deaf infants who have been exposed to American Sign Language are better at following an adult's gaze than their hearing peers, supporting the idea that social-cognitive development is sensitive to different kinds of life experiences.
Initiating breastfeeding in vulnerable infants
The benefits of breastfeeding for both mother and child are well-recognized, including for late preterm infants (LPI).
Young infants with fever may be more likely to develop infections
Infants with a high fever may be at increased risk for infections, according to research from Penn State College of Medicine.
Early term infants less likely to breastfeed
A new, prospective study provides evidence that 'early term' infants (those born at 37-38 weeks) are less likely than full-term infants to be breastfeed within the first hour and at one month after birth.
Infants are more likely to learn when with a peer
Researchers at the University of Connecticut and University of Washington looked at the mechanisms involved in language learning among nine-month-olds, the youngest population known to be studied in relation to on-screen learning.
Allergic reactions to foods are milder in infants
Majority of infants with food-induced anaphylaxis present with hives and vomiting, suggesting there is less concern for life-threatening response to early food introduction.
Non-dairy drinks can be dangerous for infants
A brief report published in Acta Paediatrica points to the dangers of replacing breast milk or infant formula with a non-dairy drink before one year of age.
Infants can't talk, but they know how to reason
A new study reveals that preverbal infants are able to make rational deductions, showing surprise when an outcome does not occur as expected.
Infants are able to learn abstract rules visually
Three-month-old babies cannot sit up or roll over, yet they are already capable of learning patterns from simply looking at the world around them, according to a recent Northwestern University study published in PLOS One.
Baby brains help infants figure it out before they try it out
Researchers at Penn State are using new statistical analysis methods to compare how we observe infants develop new skills with the unseen changes in electrical activity in the brain, or electroencephalography (EEG) power.
More Infants News and Infants Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#542 Climate Doomsday
Have you heard? Climate change. We did it. And it's bad. It's going to be worse. We are already suffering the effects of it in many ways. How should we TALK about the dangers we are facing, though? Should we get people good and scared? Or give them hope? Or both? Host Bethany Brookshire talks with David Wallace-Wells and Sheril Kirschenbaum to find out. This episode is hosted by Bethany Brookshire, science writer from Science News. Related links: Why Climate Disasters Might Not Boost Public Engagement on Climate Change on The New York Times by Andrew Revkin The other kind...
Now Playing: Radiolab

Breaking Bongo
Deep fake videos have the potential to make it impossible to sort fact from fiction. And some have argued that this blackhole of doubt will eventually send truth itself into a death spiral. But a series of recent events in the small African nation of Gabon suggest it's already happening.  Today, we follow a ragtag group of freedom fighters as they troll Gabon's president - Ali Bongo - from afar. Using tweets, videos and the uncertainty they can carry, these insurgents test the limits of using truth to create political change and, confusingly, force us to ask: Can fake news be used for good? This episode was reported and produced by Simon Adler. Support Radiolab today at Radiolab.org/donate.