NICU Culture of Care for Infants with Neonatal Abstinence Syndrome: A Focused Ethnography

AbstractPurpose: The purpose of this focused ethnography was to describe the culture of care and nonpharmacologic nursing interventions performed by NICU nurses for infants with neonatal abstinence syndrome (NAS).Method: Roper and Shapira’s1 framework for the analysis included participant observation, individual interviews, and examination of existing documents.Sample: Twelve full-time nurses were observed and interviewed.Results: Results described the culture of care provided to infants with NAS by NICU nurses as evidenced by six themes: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer/comforter, becoming an expert), grief, making a difference (wonderful insanity, critical to them), and education and care of the mother.

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Cost of neonatal abstinence syndrome: an economic analysis of English national data held in the National Neonatal Research Database

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319213 ◽

2021 ◽

pp. fetalneonatal-2020-319213

Author(s):

Philippa Rees ◽

Ben Carter ◽

Chris Gale ◽

Stavros Petrou ◽

Beverley Botting ◽

...

Keyword(s):

Direct Cost ◽

Healthcare Utilisation ◽

Routine Care ◽

Cost Of Care ◽

Neonatal Unit ◽

Neonatal Abstinence Syndrome ◽

Research Database ◽

Abstinence Syndrome ◽

Using Data ◽

Care Costs

ObjectiveTo determine the incidence of neonatal abstinence syndrome (NAS) across neonatal units, explore healthcare utilisation and estimate the direct cost to the NHS.DesignPopulation cohort study.SettingNHS neonatal units, using data held in the National Neonatal Research Database.ParticipantsInfants born between 2012 and 2017, admitted to a neonatal unit in England, receiving a diagnosis of NAS (n=6411).Main outcome measuresIncidence, direct annual cost of care (£, 2016–2017 prices), duration of neonatal unit stay (discharge HR), predicted additional cost of care, and odds of receiving pharmacotherapy.ResultsOf 524 334 infants admitted during the study period, 6411 had NAS. The incidence (1.6/1000 live births) increased between 2012 and 2017 (β=0.07, 95% CI (0 to 0.14)) accounting for 12/1000 admissions and 23/1000 cot days nationally. The direct cost of care was £62 646 661 over the study period. Almost half of infants received pharmacotherapy (n=2631; 49%) and their time-to-discharge was significantly longer (median 18.2 vs 5.1 days; adjusted HR (aHR) 0.16, 95% CI (0.15 to 0.17)). Time-to-discharge was longer for formula-fed infants (aHR 0.73 (0.66 to 0.81)) and those discharged to foster care (aHR 0.77 (0.72 to 0.82)). The greatest predictor of additional care costs was receipt of pharmacotherapy (additional mean adjusted cost of £8420 per infant).ConclusionsThis population study highlights the substantial cot usage and economic costs of caring for infants with NAS on neonatal units. A shift in how healthcare systems provide routine care for NAS could benefit infants and families while alleviating the burden on services.

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