Improving Outcomes for Infants Born With Neonatal Abstinence Syndrome

New research suggests that reducing length of treatment and hospitalization in infants diagnosed with drug withdrawal symptoms at birth can be made possible by standardizing hospital care policies across institutions.

New collaborative research led by Vermont Oxford Network, Vanderbilt and the University of Michigan Health System revealed that following a standardized protocol led to an overall reduction of one day in median length of treatment (from 17 to 16 days) and length of hospitalization was reduced by 2 days (from 21 to 19 days).

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“The rapid rise in the numbers of infants with neonatal abstinence syndrome (NAS) nationwide caught many hospitals off guard. Initially, we found that less than half of participating hospitals had policies to standardize care for affected infants,” lead author Stephen Patrick, MD, MPH, MS, assistant professor of Pediatrics and Health Policy in the Division of Neonatology at Monroe Carell Jr. Children’s Hospital at Vanderbilt, said in a statement. “Teams from 199 hospitals worked for more than 2 years to apply evidence-based and family-centered potentially better practices in their hospitals. Their hard work resulted in improvements in outcomes for this vulnerable population.”

The researchers collected data from 199 participating centers located in the United States, Canada and the United Kingdom. The investigators also provided these facilities with NAS toolkits designed to guide them through the development and implementation of a standard process for identification, evaluation, treatment and discharge of infants with NAS. From 2012 to 2014, participating institutions audited 3458 infants with NAS.

“Many of the hospitals implemented simple and inexpensive strategies, such as swaddling, soothing, skin-to-skin contact with mothers and breastfeeding to prevent escalation of withdrawal symptoms in the first few days after birth. This translated into decreased use of additional narcotics and sedatives to control withdrawal symptoms, and avoided the need for costly admission to a newborn intensive care unit,” Madge Buus-Frank, DNP, executive vice president and director of Quality Improvement and Education at Vermont Oxford Network, said in a statement.

The study’s findings revealed that the number of NAS-focused guidelines increased from 3.7 to 5.1 of a possible 6. Improvements were noted in all measured domains.

The investigators also found that there was a statistically significant decrease in the proportion of infants discharged on medication for NAS, starting from 39.7% and ending at 26.5% (P = .02).

The study was funded by grants from National Institutes of Health through the National Center for Advancing Translational Sciences and the National Institute on Drug Abuse.

Reference

Patrick S, Schumacher R, Horbar J et al. Improving Care for Neonatal Abstinence Syndrome. Pediatr. 2016. doi:10.1542/peds.2015-3835.