A Multicenter Cohort Study of Treatments and Hospital Outcomes in Neonatal Abstinence Syndrome

Hall, Eric S.; Wexelblatt, Scott L.; Crowley, Moira; Grow, Jennifer L.; Jasin, Lisa R.; Klebanoff, Mark A.; McClead, Richard E.; Meinzen‐Derr, Jareen; Mohan, Vedagiri K.; Stein, Howard; Walsh, Michele C.

doi:10.1542/peds.2013-4036

Cited by 114 publications

(102 citation statements)

References 22 publications

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“…Our study reinforces findings from smaller studies that standardizing care to infants with NAS improves clinical outcomes. 12 Over the last decade, the rate of NAS has grown substantially across the United States; however, LOS has remained stagnant. 2,6 Data suggest that hospitals vary in identification 8 and management 7,8 of infants with NAS.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies from the Ohio NAS collaborative found that standardization, defined as stringent adherence to a treatment protocol, was more effective in reducing LOS than choice of a specific opioid (ie, methadone versus morphine). 12,16 In addition to protocol adherence, the evidence for treatment improvements for NAS is building. For example, data suggest that breastfeeding an infant who has NAS, when medically appropriate, 17 can decrease the need for NAS treatment 18 ; however, breastfeeding rates among infants with NAS are reportedly low.…”

Section: Discussionmentioning

confidence: 99%

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Improving Care for Neonatal Abstinence Syndrome

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving Care for Neonatal Abstinence Syndrome

et al. 2016

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“…The details of the protocol development, including nonpharmacologic and pharmacologic components, and prestudy training in standardization of Finnegan scoring and NAS treatment have been described previously. 17,18 Infants born at $34 weeks' gestation who were treated pharmacologically for NAS with methadone or morphine were included in the analysis. Infants who received iatrogenic opioid treatment or who had significant medical conditions necessitating surgical intervention or mechanical ventilation were not included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…16 We reported that use of a protocol with stringent weaning guidelines was associated with reductions in the duration of opioid exposure and length of hospital stay regardless of the treatment opioid. 17 Subsequently, 3 study centers without a standardized weaning approach adopted the standardized protocol.…”

Section: What This Study Addsmentioning

confidence: 99%

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

et al. 2015

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, 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.

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“…For example, the Ohio Perinatal Quality Collaborative standardized the approach to neonatal abstinence syndrome, showing an almost 10-day length of stay reduction (33% decline) for infants in centers that had a morphine weaning protocol versus those that did not. 66 In the longer run, such successes might be expected to be leveraged to even better Value, as partnership with hospital administration and payers allows sharing of the gains and reinvestment into ongoing quality improvement work.…”

Section: Quality Improvementmentioning

confidence: 99%

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology

et al. 2016

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Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes.

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A Multicenter Cohort Study of Treatments and Hospital Outcomes in Neonatal Abstinence Syndrome

Cited by 114 publications

References 22 publications

Improving Care for Neonatal Abstinence Syndrome

Improving Care for Neonatal Abstinence Syndrome

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology

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