Neonatal Abstinence Syndrome: Stringent Weaning Protocol Best

Lara C. Pullen, PhD

July 29, 2014

Use of a stringent protocol to treat neonatal narcotic abstinence syndrome (NAS) reduces the duration of opioid exposure as well as the length of hospital stay, according to a new study. The benefits of a stringent protocol are significant, regardless of the opioid used for treatment.

NAS is increasing in prevalence in the United States, and yet there is currently no consensus with regard to the best treatment drug or best taper strategy for NAS management. The study advances medical understanding of the "best practice" for NAS management.

Eric S. Hall, PhD, from the Prenatal Institute at Cincinnati Children's Hospital in Ohio, and colleagues present the results of their cohort analysis in an article published online July 28 in Pediatrics. The multicenter cohort includes charted data from 547 pharmacologically treated infants and is larger than any other previously published study or meta-analysis.

"Our study identified key differences in NAS management strategies that translated into shorter opioid exposures and reduced length of hospital stay. Results indicate that the use of a stringent weaning protocol, rather than the particular opioid chosen for treatment, was the most important predictor of length of hospital stay and duration of opioid treatment,” the authors write.

“Consistent with previous literature describing improvements in pediatric outcomes through standardization of care, study results suggest that the greatest impact on outcomes is achieved through implementation and adherence to a formalized NAS treatment protocol with agreed-upon starting doses, explicit instruction about dose escalation, and strict weaning parameters," the authors explain.

The study included only infants who required opioid therapy (417 managed with an established weaning protocol and 130 managed without an established weaning protocol). After the researchers accounted for hospital variation, infants who received protocol-based weans had a significantly shorter duration of opioid treatment (17.7 vs 32.1 days; P < .0001) and shorter hospital stay (22.7 vs 32.1 days; P = .004).

Among those who received protocol-based weaning, the duration of opioid treatment and length of stay were no different in infants treated with morphine compared with those treated with methadone.

When the authors analyzed the data from patients who were treated with phenobarbital, they found a longer duration of phenobarbital administration in patients treated with morphine compared with those treated with methadone (P ≤ .002).

The protocol-driven wean described in the current study has the advantage of reducing the length of drug treatment. Such a reduction will likely improve patient safety. In addition, a stringent protocol should reduce length of hospitalization, and therefore reduce cost of care for management of NAS.

This study was supported by a State of Ohio Innovation Grant through the Ohio Office of Health Transformation. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 28, 2014. Abstract


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