Nonpharmacologic Management of Neonatal Abstinence Syndrome: An Integrative Review

2016 ◽  
Vol 35 (5) ◽  
pp. 305-313 ◽  
Author(s):  
Lindy Edwards ◽  
Lisa F. Brown

AbstractNeonatal abstinence syndrome (NAS) affects 3.39 in every 1,000 live births. A literature review was conducted to determine the varying types of nonpharmacologic management being used currently and its effect on the treatment of NAS symptoms. Fourteen articles were found that used nonpharmacologic management in the treatment of NAS. Therapies included breastfeeding, positioning, rooming-in, acupuncture/acupressure, and beds. Each of the nonpharmacologic therapies in these articles, with the exception of rocking beds, was shown to have a positive effect on the newborn with NAS. These effects include a shorter length of stay, a decrease in NAS scores, a decrease need for pharmacologic treatment, less agitation, a better quality of sleep, and a decrease in the severity of NAS symptoms. This review article shows that nonpharmacologic management is an effective tool for NAS symptom treatment.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3225-3225
Author(s):  
Cynthia L Anderson ◽  
Karin J Blakemore ◽  
Sophie Lanzkron

Abstract Abstract 3225 BACKGROUND: Little is known about the neonatal outcomes of infants born to mothers with SCD. Women with SCD are often treated for pain with opioid medication either intermittently or chronically throughout pregnancy. The incidence of withdrawal or neonatal abstinence syndrome has not been well described making counseling of these women about the risks and benefits of opioid therapy during pregnancy difficult. The objective of this study was to determine the incidence of neonatal abstinence syndrome (NAS) in babies born to women with sickle cell disease. METHODS: All pregnancies in women with sickle cell disease were identified within the Johns Hopkins Hospital between January 1, 2001 and January 1, 2011. Retrospective data collection was performed using the electronic medical record. Demographic and outcome information recorded included maternal age, gestational age at time of delivery, outcome of pregnancy, maternal genotype, neonatal intensive care unit (NICU) admissions, neonatal abstinence syndrome diagnosis and neonatal length of stay. Student t-tests and chi square analysis were used to compare outcomes as appropriate. RESULTS: 69 unique patients were identified. From these 69 women, 94 pregnancies were identified. Of these 94 pregnancies, 83 live births were noted. The other 11 pregnancies included 3 spontaneous abortions, 3 ectopic pregnancies, 4 terminations and 1 fetal death in utero. The mean maternal age at time of delivery was 25.5 +/− 5.1 years. The mean gestational age was 36 weeks 2 days (median 36 weeks 6 days with a range of 31 weeks 4 days to 39 weeks 3 days). Of the 83 live births noted in this retrospective cohort, 22 (27%) of these infants were admitted to the NICU and17 (20%) were diagnosed with neonatal abstinence syndrome. Of the 17 infants born with NAS, 12 infants (70%) were born to mothers with SS disease, 3 infants (18%) to mothers with Sβthalassemia and 2 infants (12%) to mothers with SC disease. 53% of babies born with NAS were delivered by C-section which was not statistically significantly different than babies born without NAS (42% p=0.60) The mean birth weight of the babies with NAS was 2521 grams compared to babies without NAS which was 2853 grams (p=0.07). 59% of babies with NAS required NICU care compared to 16% of babies without NAS (p<0.001). The mean length of stay for babies with NAS was significantly longer than those babies without NAS (14.7 days vs. 5.8 days, p=0.003). Of the babies without NAS, 44% had extended hospital stays due to baby-associated complications and the mean LOS was 10.6 days; 10% had extended hospital stays due to complications of the mother with a mean LOS of 6.5 days; and the mean LOS for the 45% of those without mother or baby complications was 2.5 days. CONCLUSIONS: Current recommendations include the use of opioids as needed for vaso-occlusive pain in pregnancies complicated by sickle cell disease. While effective, our study demonstrates that a significant percentage of infants exposed to opioids in utero develop neonatal abstinence syndrome. Future studies are indicated to delineate a dose-response relationship if one exists as well as alternative therapies to address this newly recognized important neonatal co-morbidity. Disclosures: Lanzkron: Hemaquest: Membership on an entity's Board of Directors or advisory committees; NHLBI: Research Funding.


CNS Spectrums ◽  
2008 ◽  
Vol 13 (S17) ◽  
pp. 10-12
Author(s):  
David Neubauer

Because a multitude of factors contribute to insomnia, the context of treatment can greatly impact treatment efficacy. Major depression or congestive heart failure, for example, can contribute to insomnia, and treatment of those conditions should exert a positive effect on insomnia symptoms. On the other hand, the treatment of other conditions, such as the use of selective serotonin reuptake inhibitors antidepressants, may have a negative effect on the quality of sleep. Clinicians, therefore, need to take a versatile, multifaceted approach for each patient when treating insomnia.


2019 ◽  
Vol 17 (3) ◽  
pp. 283-289
Author(s):  
S. Slavov

Sleep disorders are common symptoms in patients with rheumatological diseases. Quality of sleep in patients with chronic pain affects their physical, psychological, cognitive, emotional and social functioning. Regardless of the large number of studies dealing with the relation between sleep and chronic pain, there is a deficit in the scientific literature when specific sleep disorders are associated with different rheumatological diseases. This review article is a literature review of the issue referring to the relation between the sleep disorders, quality of sleep and chronic pain in patients with rheumatological diseases. Presented is a large amount of scientific literature data reflecting the modern trends in the chronic pain-sleep disorders relation, as well as the psychosocial factors with an effect on the patients suffering from rheumatological diseases.


2021 ◽  
Vol 11 (9) ◽  
pp. 968-981
Author(s):  
Corrie E. McDaniel ◽  
Elizabeth Jacob-Files ◽  
Parimal Deodhar ◽  
Caitlin L. McGrath ◽  
Arti D. Desai

2018 ◽  
Vol 38 (12) ◽  
pp. 1651-1656 ◽  
Author(s):  
Hayley Friedman ◽  
Gregory Parkinson ◽  
Hocine Tighiouart ◽  
Catherine Parkinson ◽  
David Tybor ◽  
...  

Author(s):  
Chinyere N. Reid ◽  
Tara R. Foti ◽  
Alfred K. Mbah ◽  
Mark L. Hudak ◽  
Maya Balakrishnan ◽  
...  

2020 ◽  
pp. 174498712094679
Author(s):  
Dean A Anderson ◽  
Victoria Clemett

Background The inclusion of specialist nurses in multi-disciplinary teams is the current gold standard for care of people with heart failure (HF) in the UK; however, they remain underutilised in practice. Though existing systematic reviews favourably compare advanced nursing roles to physician-led care, none has focused solely on HF. Aim To investigate the impact of specialist and advanced nurse-led care on the clinical outcomes, quality of life and satisfaction of people with HF compared to physician-led care. Methods Literature review and narrative synthesis. Results This review included 12 studies and categorised their measured outcomes into five domains: mortality; hospital admissions and length of stay; HF diagnosis and management; quality of life and patient satisfaction; and finally, self-assessment and self-care. Five studies appraised as medium or low risk of bias suggest the impact of specialist and advanced-level nurses on people with HF to be broadly equivalent to physicians regarding mortality, hospital admissions and length of stay, while superior in terms of self-assessment and self-care behaviours. Conclusions There were too few studies of sufficient methodological quality to draw definitive conclusions. However, no evidence was found to suggest that nurse-led services are any less effective or safe than physician-led services.


PEDIATRICS ◽  
2020 ◽  
Vol 146 (4) ◽  
pp. e20190914
Author(s):  
Heather C. Kaplan ◽  
Pierce Kuhnell ◽  
Michele C. Walsh ◽  
Moira Crowley ◽  
Richard McClead ◽  
...  

2019 ◽  
Vol 25 (7) ◽  
pp. 414-418
Author(s):  
Amanda Hignell ◽  
Karen Carlyle ◽  
Catherine Bishop ◽  
Mary Murphy ◽  
Teresa Valenzano ◽  
...  

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.


2017 ◽  
Vol 35 (04) ◽  
pp. 405-412 ◽  
Author(s):  
Ward Rice ◽  
Alonzo Folger ◽  
Scott Wexelblatt ◽  
Eric Hall

Objective The objective of this study was to compare duration of opioid treatment and length of stay outcomes for neonatal abstinence syndrome (NAS) using sublingual buprenorphine versus traditional weaning with methadone or morphine. Study Design This retrospective cohort analysis evaluated infants treated for NAS at a single community hospital from July 2013 through June 2017. A standardized weaning protocol was introduced in June 2015, allowing for treatment with sublingual buprenorphine regardless of type of intrauterine opioid exposure. General linear models were used to calculate adjusted mean duration of opioid treatment and length of hospitalization with 95% confidence intervals for infants treated with buprenorphine compared with traditional weaning with either methadone or morphine. Results A total of 360 infants were treated with either buprenorphine (n = 174) or a traditional opioid (n = 186). Infants treated with buprenorphine experienced a 3.0-day reduction in opioid treatment duration of 7.4 (6.3–8.5) versus 10.4 (9.3–11.5) days (p < 0.001) and a 2.8-day reduction in length of stay of 12.4 (11.3–13.6) versus 15.2 (14.1–16.4) days (p < 0.001). Conclusion Our study provides an independent confirmation that among infants experiencing NAS following a wide array of intrauterine opioid exposures, buprenorphine weaning supports a shortened treatment duration compared with conventional weaning agents.


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