OBJECTIVES: To compare pharmacologic treatment strategies for neonatal abstinence syndrome (NAS) with respect to total duration of opioid treatment and length of inpatient hospital stay. METHODS: We conducted a cohort analysis of late preterm and term neonates who received inpatient pharmacologic treatment of NAS at one of 20 hospitals throughout 6 Ohio regions from January 2012 through July 2013. Physicians managed NAS using 1 of 6 regionally based strategies. RESULTS: Among 547 pharmacologically treated infants, we documented 417 infants managed using an established NAS weaning protocol and 130 patients managed without protocol-driven weaning. Regardless of the treatment opioid chosen, when we accounted for hospital variation, infants receiving protocol-based weans experienced a significantly shorter duration of opioid treatment (17.7 vs 32.1 days, P < .0001) and shorter hospital stay (22.7 vs 32.1 days, P = .004). Among infants receiving protocol-based weaning, there was no difference in the duration of opioid treatment or length of stay when we compared those treated with morphine with those treated with methadone. Additionally, infants treated with phenobarbital were treated with the drug for a longer duration among those following a morphine-based compared with methadone-based weaning protocol. (P ≤ .002). CONCLUSIONS: Use of a stringent protocol to treat NAS, regardless of the initial opioid chosen, reduces the duration of opioid exposure and length of hospital stay. Because the major driver of cost is length of hospitalization, the implications for a reduction in cost of care for NAS management could be substantial.

No abstract

, 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.

Implementation of a standardized approach to nutrition in VLBW infants reduces the use of PN thereby reducing cost, causes a more rapid regain of birth weight, decreases the number of babies that are small for gestational age and microcephalic at discharge, and decreases the time to full enteral feeds. No adverse increases in mortality, sepsis, NEC, coagulase-negative Staphlococcal infections or line infections occurred.

The neonatal rat model of unilateral cerebral hypoxia-ischemia (HI) is commonly used to test the efficacy of therapeutic strategies for prevention or treatment of stroke in the immature brain. Traditionally neuroprotection has been defined as reduction in tissue injury; there is growing interest in complementary functional assessment. Our objectives were to determine whether lateralizing performance deficits could be detected in two sensorimotor tests not previously used after neonatal HI, and to determine whether performance reflected the extent of tissue damage. Seven-day-old rats that underwent right carotid ligation followed by 1.5 h in 8% O₂ and age-matched controls were tested for sensorimotor performance on postnatal day 35 (P35). We evaluated initial forepaw placement on the wall of a cylinder, and time taken to contact and remove adhesive stickers from the dorsum of each forepaw. Cortical, striatal and hippocampal damage severity was evaluated on P36 by calculating the contralateral-ipsilateral percent difference in regional areas. There was an inverse relationship between cortical and striatal damage severity and percent contralateral forepaw initiation in the cylinder. There was a direct linear relationship between damage severity and the delay from contact to removal of the contralateral sticker. These two tests revealed quantifiable contralateral sensorimotor deficits 4 weeks after unilateral neonatal cerebral HI in animals with cortical and striatal damage.