Nurses' Finnegan Scoring of Newborns with Neonatal Abstinence Syndrome Not Affected by Time or Day of the Week

2019 ◽  
Vol 37 (02) ◽  
pp. 224-230 ◽  
Author(s):  
Alla Kushnir ◽  
Jennifer L. Bleznak ◽  
Judy G. Saslow ◽  
Gary Stahl
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Time Of Day ◽  
Behavioral Changes ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Institutional Review ◽  
Day Of The Week ◽  
Scoring Tool

Abstract Objective Newborns exposed to drugs in utero are at risk of developing neonatal abstinence syndrome (NAS), characterized by behavioral changes and physiologic instability. Finnegan scoring tool quantifies severity of symptoms and guides treatment. This article evaluates whether time of day and the number of shift hours affects modified Finnegan scores, and the subjective component of these scores. Study Design Institutional review board-approved, retrospective chart review of newborns admitted to neonatal intensive care or transitional nursery from 2011 to 2014. Inclusion criteria: > 35 weeks' gestation, known maternal substance use, positive maternal or newborn urine, or meconium drug screen, NAS treatment. Results A total of 101 charts were evaluated. Mean treatment duration was 31.8 days (standard deviation ±18.3). There was no significant relationship between observer shift hour and high scores (> 8) (p = 0.83). Highest scores occurred in the afternoon, decreased at night (p = 0.03), and throughout admission (p < 0.0001). Weekend and weekday scores were similar (p = 0.4). The objective component of the scores remained similar throughout the day (p = 0.91) and week (p = 0.52). Conclusion Finnegan scores given by nurses were not influenced by shift hour. Time of day did not influence overall high scores or the proportion of objective to total Finnegan score. Inter-rater reliability was maintained regardless of time of day or day of the week.

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

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.

scholarly journals A Comparison of Morphine Delivery in Neonatal Opioid Withdrawal

2016 ◽  
Vol 10s1 ◽  
pp. SART.S34550 ◽  
Author(s):  
Brian Chisamore ◽  
Safaa Labana ◽  
Sandra Blitz ◽  
Alice Ordean
Keyword(s):  
Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Opioid Withdrawal ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Chart Audit ◽  
Newborn Period ◽  
Treatment Protocols ◽  
Scoring Tool ◽  
Delivery Models

Current estimates of the prevalence of opioid withdrawal in newborns from the 2012 Better Outcomes Registry and Network Ontario reveal that more than 4 births per 1000 display recognizable symptoms of neonatal abstinence syndrome (NAS). With a growing consensus surrounding aspects of newborn opioid withdrawal care, clinicians might agree that all infants exposed to maternal opioids require supportive observation and care to ensure appropriate adaptation and growth in the newborn period and, likewise, that there exists a smaller percentage of newborns who require additional pharmacotherapy. However, due to the dearth of comparative studies of NAS tools, there remains a lack of evidence to support the use of a specific NAS method of scoring or treatment. Two types of NAS treatment protocols currently in use include a symptom-only versus weight-based protocols. Our Neonatal Intensive Care Unit (NICU) has used both models. A formal structured NAS tool and weight-based morphine delivery system began in our NICU in 1999. We audited all newborns with known exposure to maternal opioids in our NICU from the years 2000 to 2014. The Finnegan scoring tool was used throughout all years of the chart audit. Modifications made to the Finnegan scoring tool from the MOTHER study were adapted for use in our NICU at the same time as adopting the Johns Hopkins model of symptom-only based morphine delivery in 2006. The objective of this comparative study using a retrospective chart audit is to compare length of stay (LOS) and total accumulative morphine dose across these two morphine delivery protocols. Our audit revealed that there were a significantly higher proportion of newborns in the symptom-only model that received morphine and, perhaps accordingly, also had a significantly higher LOS compared to those in the weight-based model. Comparing only those infants who did receive morphine, the comparative total accumulative dose of morphine and LOS were not significantly different between the weight-based and symptom-only morphine delivery models.

Late-onset pubic-phallic idiopathic edema in premature recovering infants

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Bengt-Ola S. Bengtsson ◽  
John P. van Houten
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Late Onset ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Genital Area ◽  
Level 3 ◽  
Prolonged Observation ◽  
Idiopathic Edema

AbstractObjectiveSeveral cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature.Study designA retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017.ResultsA total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)].ConclusionsTo our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.

scholarly journals Evaluation of the Cardiovascular Effects of Clonidine in Neonates Treated for Neonatal Abstinence Syndrome

2018 ◽  
Vol 23 (6) ◽  
pp. 473-478
Author(s):  
Raymond P. Meddock ◽  
Deirdre Bloemer
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Neonatal Intensive Care ◽  
Dose Range ◽  
Safety Data ◽  
Cardiovascular Effects ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome

OBJECTIVES Neonatal abstinence syndrome (NAS) is characterized by withdrawal symptoms in neonates exposed to legal or illegal substances in utero, and it is often managed with medications such as opiates, phenobarbital, and clonidine. Clonidine use is increasing, but further safety data regarding its use in neonates are warranted. This study evaluated the effects of clonidine on heart rate and blood pressure in neonates treated for NAS at doses up to 24 mcg/kg/day. METHODS A retrospective review via the electronic medical record of infants at least 35 weeks' gestation treated adjunctively with clonidine for NAS in the neonatal intensive care unit at St Elizabeth was conducted. Heart rate, and systolic and diastolic blood pressure were recorded at baseline, while on different dose ranges of clonidine (small: ≤1.5 mcg/kg per dose every 3 hours; medium: &gt;1.5 to 2 mcg/kg per dose every 3 hours; and large: &gt;2 mcg/kg to 3 mcg/kg per dose every 3 hours), and upon discontinuation. RESULTS A total of 64 infants treated with clonidine for NAS between August 2015 and December 2016 were included. Heart rate decreased in all clonidine dose ranges compared with baseline (average reduction of 7 bpm [CI: −12 to −2], 9 bpm [CI: −16 to −2], and 10 bpm [CI: −18 to −1] for the small, medium, and large dose ranges, respectively; p &lt; 0.0001). Systolic and diastolic blood pressure were not significantly different from baseline when infants were receiving any dose of clonidine, except diastolic blood pressure while on medium–dose range clonidine, where diastolic blood pressure was higher than baseline (p = 0.0128). Increases in systolic and diastolic blood pressure were evident upon discontinuation of clonidine (p &lt; 0.0001 and p = 0.0156, respectively). CONCLUSIONS Clonidine doses up to 24 mcg/kg/day are well tolerated in neonates ≥35 weeks' gestation treated for NAS. Any decreases in heart rate are likely clinically insignificant, and increases in blood pressure upon discontinuing clonidine are mild and may be mitigated further with extended discontinuation protocols. Further trials should be conducted to evaluate the long-term safety of clonidine in this population.

scholarly journals Project Console: a quality improvement initiative for neonatal abstinence syndrome in a children’s hospital level IV neonatal intensive care unit

2021 ◽  
Vol 10 (2) ◽  
pp. e001079
Author(s):  
Kathryn L Ponder ◽  
Charles Egesdal ◽  
Joanne Kuller ◽  
Priscilla Joe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Abstinence Syndrome ◽  
Quality Improvement Initiative ◽  
Abstinence Syndrome ◽  
Post Intervention ◽  
High Acuity

ObjectiveTo improve care for infants with neonatal abstinence syndrome.DesignInfants with a gestational age of ≥35 weeks with prenatal opioid exposure were eligible for our quality improvement initiative. Interventions in our Plan–Do–Study–Act cycles included physician consensus, re-emphasis on non-pharmacological treatment, the Eat Sleep Console method to measure functional impairment, morphine as needed, clonidine and alternative soothing methods for parental unavailability (volunteer cuddlers and automated sleeper beds). Pre-intervention and post-intervention outcomes were compared.ResultsLength of stay decreased from 31.8 to 10.5 days (p<0.0001) without an increase in readmissions. Composite pharmacotherapy exposure days decreased from 28.7 to 5.5 (p<0.0001). This included reductions in both morphine exposure days (p<0.0001) and clonidine exposure days (p=0.01). Fewer infants required pharmacotherapy (p=0.02).ConclusionsOur study demonstrates how a comprehensive initiative can improve care for infants with neonatal abstinence syndrome in an open-bay or a high-acuity neonatal intensive care unit when rooming-in is not available or other comorbidities are present.

scholarly journals Gender Differences in Withdrawing Infants

2018 ◽  
Vol 5 ◽  
pp. 2333794X1877588 ◽  
Author(s):  
Sarah Stevens ◽  
Tyler Flaugher ◽  
Kaitlynn Hughes ◽  
Carson Terwilliger ◽  
Jessica Copley ◽  
...  
Keyword(s):  
Gender Differences ◽  
Head Circumference ◽  
Online Survey ◽  
Growth Parameters ◽  
Retrospective Chart Review ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Long Term Effects ◽  
Male And Female ◽  
Survey Tool

Objective. To assess gender differences in infants diagnosed with neonatal abstinence syndrome at the Cabell Huntington Hospital in Huntington, West Virginia. Methods. This is a single-site retrospective chart review involving 97 infants born treated for neonatal abstinence syndrome at the Cabell Huntington Hospital between April and December 2015. Data were obtained from electronic medical records using a secure online survey tool designed using Qualtrics. Maternal demographics and drug screenings were collected. Infant information was collected for the first 7 days of life including withdrawal symptoms, treatment, and growth parameters. These data were analyzed based on gender, male (N = 62) and female (N = 35), to assess any gender differences among the infants. Results. No significant differences were found regarding birth weight, length, and gestational age between male and female infants. Differences among the percentage of symptoms experienced were found with females experiencing a greater percentage of symptoms affecting the autonomic nervous system compared with males. Significant differences in head circumference were found in these infants; females were found to have a greater head circumference at time of birth compared with males ( P = .003), whereas at time of discharge head circumference was greater in males than in females ( P = .035). Conclusion. Differences in symptoms, physical characteristics, and methadone treatment were found between male and female infants diagnosed with neonatal abstinence syndrome at the Cabell Huntington Hospital during 2015. Further studies are needed to assess both the short- and long-term effects of antenatal drug abuse.

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