Rooming-in for Infants at Risk for Neonatal Abstinence Syndrome: Outcomes 5 Years following Its Introduction as the Standard of Care at One Hospital

Abstract

Objective The practice of rooming-in for opioid-dependent infants was introduced as the standard of care at our hospital following a pilot study which demonstrated that such infants had shorter lengths of stay and were less likely to require pharmacological treatment. We sought to determine whether these benefits have continued, and whether outcomes support continuing to use rooming-in as standard care. Study Design Opioid-dependent infants delivered at 36 weeks gestation or later between January 1, 2015, and December 31, 2019, were eligible for rooming-in. Charts were reviewed and data were extracted regarding maternal and infant conditions, whether neonatal pharmacological treatment was required, and total length of hospital stay. Outcomes were compared with two historical groups reported in a previous pilot study: 24 healthy near-term opioid-dependent newborns who were admitted directly to the neonatal intensive care unit (NICU) prior to the introduction of rooming-in (May 1, 2012–May 31, 2013), and 20 similar opioid-dependent infants who were the first to room-in at our hospital (September 1, 2013–September 30, 2014). Results Only 3.5% of 57 infants who roomed-in during the 5-year study period required pharmacological treatment, compared with 15% who roomed-in during the first year of the program's introduction and 83.3% who had been admitted directly to the NICU. The median length of stay remained 5 days for infants rooming-in, compared with 24 days for opioid-dependent infants in the cohort admitted to the NICU. Conclusion Early observations of the benefits of rooming-in on neonatal outcomes were sustained. Infants allowed to room-in were significantly less likely to require initiation of pharmacotherapy and a prolonged hospital stay than similar infants prior to the implementation of rooming-in as standard care. A large proportion of the infants who might have benefited from rooming-in required admission to the NICU for reasons other than neonatal abstinence syndrome (NAS). Key Points

Early Postnatal Outcome and Care after in Utero Exposure to Lithium: A Single Center Analysis of a Belgian Tertiary University Hospital

“…Depending on the respiratory and general status of the neonate, this can be done at a medium care unit (NICU if respiratory or other NICU support is needed). In literature, rooming-in for infants at risk for NAS from in utero opioid exposure is supported [ 48 , 49 ]. Multidisciplinary assessment of the maternal medical and psychosocial condition is needed for women suffering from bipolar disorder to decide (often case-by-case) if rooming-in is a suitable option.…”

The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention

“…The MAiN rooming-in program was safe, effective, and reduced costs by more than 50% when using non-critical care beds compared with NICU beds as the main cost driver [ 27 ]. Multiple studies corroborate these findings, identifying that nonpharmacological strategies such as rooming-in for NAS management compared to NICU care were associated with a shorter hospital LOS and a decreased need for pharmacological treatment, thereby lowering hospitalization costs [ 26 , 28 , 29 ].…”

“…Data from existing programs in Canada and the US confirm that mothers can successfully provide care in hospital with support from staff prior to transitioning home [ 15 , 26 ]. Programs introduced to address NAS management challenges, like the Managing Abstinence in Newborns (MAiN) program, include family-centred care, methadone treatment, and rooming-in with mothers, found mean costs of $10,946.96 versus $44,544.17 (2014 USD) for infants who received routine NICU care.…”

Prenatal opioid-exposed infant extracellular miRNA signature obtained at birth predicts severity of neonatal opioid withdrawal syndrome

“…While some protective factors have been identified, i.e. the type of maternal MOUD (buprenorphine vs. methadone), initiation of breastfeeding, rooming-in practices, non-pharmacological interventions, and genetics 18 – 22 , large unexplained variability in the severity of NOWS symptoms suggest that additional factors might be at play. Current tools to measure NOWS severity rely on the detection and scoring of symptoms 23 – 28 .…”