Development and application of a primer and reference assessment tool for neonatal abstinence syndrome: A phase I pilot study

Abstract Objectives St. Michael’s Hospital launched a volunteer cuddling program for all infants admitted into the neonatal intensive care unit in October 2015. The program utilizes trained volunteers to cuddle infants when caregivers are not available. This was a pilot study to assess the impact of a volunteer cuddle program on length of stay (LOS) and feasibility of implementation of the program. Methods A mixed methods approach was utilized to measure both quantitative and qualitative impact. A pilot cohort study with a retrospective control group assessed the feasibility of implementing a volunteer cuddling program for infants with neonatal abstinence syndrome (NAS). Length of stay was used as a surrogate marker to measure the impact of cuddling on infants being treated for Neonatal Abstinence Syndrome. Focus groups using semi-structured interviews were conducted with volunteers and nurses at the end of the pilot study. Results LOS was reduced by 6.36 days (U=34, P=0.072) for infants with NAS in the volunteer cuddling program. Focus groups with both bedside nurses and program volunteers described a positive impact of cuddling programs on infants, families, staff, and volunteers alike. Conclusions The study results suggest that the volunteer cuddling program may reduce LOS in infants with NAS and have potential economic savings on hospital resources. However, larger prospective cohort studies are needed to confirm these results.

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Pharmacokinetics of Oral Methadone in the Treatment of Neonatal Abstinence Syndrome: A Pilot Study

The Journal of Pediatrics ◽

10.1016/j.jpeds.2015.08.032 ◽

2015 ◽

Vol 167 (6) ◽

pp. 1214-1220.e3 ◽

Cited By ~ 24

Author(s):

Jason R. Wiles ◽

Barbara Isemann ◽

Tomoyuki Mizuno ◽

Meredith E. Tabangin ◽

Laura P. Ward ◽

...

Keyword(s):

Pilot Study ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Oral Methadone

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Opioid Withdrawal During Pregnancy and Rates of Neonatal Abstinence Syndrome (NAS): A Pilot Study [27Q]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000558946.96642.02 ◽

2019 ◽

Vol 133 (1) ◽

pp. 187S-188S

Author(s):

Angela Jessica Stephens ◽

Lina Maria Tibavinsky Bernal ◽

Linda Street ◽

Paul Browne

Keyword(s):

Pilot Study ◽

Opioid Withdrawal ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome

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Evaluation and analysis of the Modified Finnegan Scoring System for assessment of neonatal abstinence syndrome

Journal of Opioid Management ◽

10.5055/jom.2020.0567 ◽

2020 ◽

Vol 16 (3) ◽

pp. 189-196

Author(s):

Rafia Q. Baloch, MD ◽

Jamie M. Pinto, MD ◽

Patricia Greenberg, MS ◽

Yen-Hong Kuo, PhD ◽

Anita Siu, PharmD, BCPPS

Keyword(s):

Vital Sign ◽

Scoring System ◽

Neonatal Intensive Care ◽

Primary Outcome ◽

Assessment Tool ◽

Vital Signs ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Scoring Tool ◽

Study Setting

Objective: The Finnegan Neonatal Abstinence Scoring System (FNASS) is the most commonly used scoring system for neonatal abstinence syndrome (NAS) both in its original and modified versions, despite challenges related to tool length and observer bias. The purpose of this study was to determine the most frequent symptoms of NAS that led to score elevation and prompted initiation of drug therapy on the Modified Finnegan (MF). We also sought to identify vital sign changes associated with score elevation.Design: We conducted a retrospective study of neonates diagnosed with NAS, based on ICD-9 codes and charge data for methadone administration.Setting: The study setting was in a Level III Neonatal Intensive Care Unit.Patients, Participants: Ninety patients with a total of 286 MF scores recorded from 2011 to 2015 met inclusion criteria.Main Outcome Measure(s): The primary outcome was overall occurrence for each specific component of the MF scoring tool during symptomatic periods. Secondary outcomes were vital sign changes.Results: Among the MF elements, there were 13 components that were scored more often than others in symptomatic infants. Respiratory rate (RR) was elevated in infants with NAS, but other vital signs did not differ from age-specific norms. Conclusions: Of the various signs of NAS used to score the MF, few are frequently observed. Our study reinforces literature that proposes a shortened MF assessment tool. Experimental research will be needed to determine the efficacy of a shortened MF tool for diagnosing NAS.

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Amplitude-integrated EEG use in neonatal abstinence syndrome: a pilot study

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2019.1579190 ◽

2019 ◽

Vol 33 (21) ◽

pp. 3565-3570 ◽

Cited By ~ 1

Author(s):

Jamie Limjoco ◽

Lucyna Zawadzki ◽

Meghan Belden ◽

Jens Eickhoff ◽

Chrysanthy Ikonomidou

Keyword(s):

Pilot Study ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome

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

American Journal of Perinatology ◽

10.1055/s-0040-1719182 ◽

2020 ◽

Author(s):

Adam Isaiah Newman ◽

Dane Mauer-Vakil ◽

Helen Coo ◽

Lynn Newton ◽

Emily Wilkerson ◽

...

Keyword(s):

Pilot Study ◽

Hospital Stay ◽

Pharmacological Treatment ◽

Standard Care ◽

Neonatal Intensive Care ◽

Length Of Hospital Stay ◽

Standard Of Care ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Lengths Of Stay

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

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Aromatherapy as an adjunctive therapy for neonatal abstinence syndrome: A pilot study

Journal of Opioid Management ◽

10.5055/jom.2020.0558 ◽

2020 ◽

Vol 16 (2) ◽

pp. 119-125

Author(s):

John M. Daniel, IV, MD, MS ◽

Lesley N. Davidson, MD, MS ◽

Jennifer R. Havens, PhD, MPH ◽

John A. Bauer, PhD ◽

Lori A. Shook, MD

Keyword(s):

Pilot Study ◽

Standard Therapy ◽

Neonatal Intensive Care ◽

Therapy Group ◽

Primary Diagnosis ◽

Hospital Length Of Stay ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Current Standard ◽

Standard Therapy Group

Objective: To determine if aromatherapy added to the current standard of care for opioid withdrawal syndrome decreases hospitalization and need for opioid replacement in neonates.Design: Nonblinded, randomized control trial. Setting: Level 4 neonatal intensive care unit (NICU).Patients and participants: Thirty eight patients met inclusion criteria of greater than or equal to 36 weeks of gestation, history of intrauterine opioid exposure, primary diagnosis of neonatal abstinence syndrome (NAS), and parental permission to participate.Interventions: Infants were randomized to either a standard therapy group or a standard therapy plus aromatherapy.Main outcome measure(s): Duration of therapy and length of stay.Results: Our pilot study showed that the use of aromatherapy in conjunction with standard therapy reduced the duration of medication treatment by 41 percent and hospital length of stay in the NICU by 36 percent.Conclusions: The use of aromatherapy appears to help mitigate symptoms of NAS and offers to be a viable treatment modality when used with conventional therapy.

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Outpatient Healthcare Access and Utilization for Neonatal Abstinence Syndrome Children: A Systematic Review

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.418 ◽

2019 ◽

pp. 1-24

Author(s):

Adam Van Horn ◽

Whitney Powell ◽

Ashley Wicker ◽

Anthony D. Mahairas ◽

Liza M. Creel ◽

...

Keyword(s):

Healthcare Utilization ◽

Assessment Tool ◽

Healthcare Access ◽

Childhood Mortality ◽

Neonatal Abstinence Syndrome ◽

Health Study ◽

Abstinence Syndrome ◽

Appointment Adherence ◽

Cochrane Database ◽

Lost To Follow Up

Abstract Objective: The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children. Methods: A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, CINAHL, and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool. Results: This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitate healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population. Conclusions: This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for neonatal abstinence syndrome infants. NAS infants tend to have decreased access to, and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.

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Pilot Study Comparing Adverse Cardiorespiratory Events among Pharmacologically and Nonpharmacologically Treated Infants Undergoing Monitoring for Neonatal Abstinence Syndrome

The Journal of Pediatrics: X ◽

10.1016/j.ympdx.2020.100027 ◽

2020 ◽

Vol 3 ◽

pp. 100027

Author(s):

Spoorthi Davala ◽

Aaron Hansbury ◽

Melissa Miller ◽

Jeffery Boateng ◽

Hira Shrestha ◽

...

Keyword(s):

Pilot Study ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome

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Outpatient healthcare access and utilization for neonatal abstinence syndrome children: A systematic review

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.407 ◽

2019 ◽

Vol 4 (5) ◽

pp. 389-397

Author(s):

Adam Van Horn ◽

Whitney Powell ◽

Ashley Wicker ◽

Anthony D. Mahairas ◽

Liza M. Creel ◽

...

Keyword(s):

Healthcare Utilization ◽

Assessment Tool ◽

Healthcare Access ◽

Childhood Mortality ◽

Neonatal Abstinence Syndrome ◽

Health Study ◽

Abstinence Syndrome ◽

Appointment Adherence ◽

Cochrane Database ◽

Lost To Follow Up

AbstractObjective:The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children.Methods:A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle–Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool.Results:This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitates healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population.Conclusions:This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for NAS infants. NAS infants tend to have decreased access to and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.

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