Neonatal Abstinence Syndrome Practices in the United States

Abstract

OBJECTIVE To survey current practices for the treatment of neonatal abstinence syndrome (NAS) among institutions in the United States to identify changes in national practice over time. METHODS Previous NAS management reports were referenced in the development of our 26-question electronic survey, which was distributed in the fall of 2019 to pediatric practitioners of 2 national clinical pharmacy organizations via email list servers. Not all questions required a response and responses from incomplete surveys were included. Institution demographics and NAS management strategies, including location of care, observation period, and inpatient and outpatient pharmacotherapy, were queried. RESULTS Seventy respondents representing institutions from all US geographic regions participated in the survey The most commonly reported inpatient observation durations were 3 (18 of 61, 29%) and 5 (22 of 61, 36%) days. Respondents indicated that neonates were typically transferred to the NICU if pharmacologic management was required (38 of 56, 68%). According to participants, first-line agents used for NAS management were morphine (45 of 56, 80%), methadone (5 of 56, 9%), clonidine (2 of 56, 4%), and buprenorphine (2 of 56, 4%). Among respondents, only 20% (11 of 56) reported that infants may be discharged home on pharmacotherapy, including morphine (n = 6), phenobarbital (n = 3), clonidine (n = 1), and methadone (n = 1). CONCLUSIONS Opioids are the most commonly used first-line agents for NAS management in the United States. The primary site of NAS management is the inpatient setting, as only 20% of institutions report discharging patients on pharmacotherapy.

Assessing the Eat, Sleep, Console model for neonatal abstinence syndrome management at a regional referral center

“…The Finnegan Neonatal Abstinence Scoring System (FNASS), often modified, is a popular tool for assessment of both opioid and non-opioid withdrawal [8][9][10]. The FNASS was designed to systematically assesses signs and symptoms associating with NAS [2,8,11].…”

Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in Maryland

“…1 There is substantial variability in the incidence of NAS, models of NAS care, and NAS outcomes such as length of stay (LOS) and costs of care across hospitals. [5][6][7] Large national, state, and single-center collaborative quality improvement initiatives targeted at standardizing the approach to care of infants with NAS have reduced length of hospital stay, the rate and duration of pharmacologic treatment, and the total cost of care. [8][9][10][11] Like many states, Maryland witnessed a substantial increase in the rate of NAS to 13.4 per 1,000 live births by 2014.…”

“…1 There is substantial variability in the incidence of NAS, models of NAS care, and NAS outcomes such as length of stay (LOS) and costs of care across hospitals. 5 6 7…”

Using the Eat Sleep Console Model to Promote Optimal Care and Outcomes for Infants With Neonatal Abstinence Syndrome

“…While the NICU has historically been deemed the optimal treatment setting, nurses have expressed concerns about inadequacies of critical care settings for infants with NAS 6. Finally, the current state of care for infants with NAS in the United States is marked by variation in treatment protocols, which impacts the quality of care and outcomes 7,8…”

“…6 Finally, the current state of care for infants with NAS in the United States is marked by variation in treatment protocols, which impacts the quality of care and outcomes. 7,8 The Finnegan score has long been used to treat infants with NAS, focusing on the presence and severity of withdrawal symptoms and using a point system to determine the need for pharmacotherapy. 9 In the United States, the modified Finnegan score is the most common assessment tool used to guide treatment of infants with NAS.…”