Dataset Information

Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey.

ABSTRACT: Objective: Assess management of neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices.

Study design: We fielded an internet-based survey of 37 questions to medical directors or nurse managers at 145 birth hospitals in California.

Results: Seventy-five participants (52%) responded. Most respondents reported having at least one written protocol for managing NAS, but gaps included protocols for pharmacologic management. Newer tools for assessing NAS severity were not commonly used. About half reported usually or always using nonpharmacologic strategies; there is scope for increasing breastfeeding when recommended, skin-to-skin care, and rooming-in.

Conclusions: We found systematic gaps in care for infants with NAS in a sample of California birth hospitals, as well as opportunities to spread best practices. Adoption of new approaches will vary across hospitals. A concerted statewide effort to facilitate such implementation has strong potential to increase access to evidence-based treatment for infants and mothers.

SUBMITTER: Clemans-Cope L

PROVIDER: S-EPMC7042156 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey.

Clemans-Cope Lisa L Holla Nikhil N Lee Henry C HC Cong Allison Shufei AS Castro Robert R Chyi Lisa L Huang Angela A Taylor Kimá Joy KJ Kenney Genevieve M GM

Journal of perinatology : official journal of the California Perinatal Association 20200107 3

<h4>Objective</h4>Assess management of neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices.<h4>Study design</h4>We fielded an internet-based survey of 37 questions to medical directors or nurse managers at 145 birth hospitals in California.<h4>Results</h4>Seventy-five participants (52%) responded. Most respondents reported having at least one written protocol for managing NAS, but gaps included protocols for pharmacol ...[more]

PMID: 31911649

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Project description:BackgroundMethadone, a full mu-opioid agonist, is the recommended treatment for opioid dependence during pregnancy. However, prenatal exposure to methadone is associated with a neonatal abstinence syndrome (NAS) characterized by central nervous system hyperirritability and autonomic nervous system dysfunction, which often requires medication and extended hospitalization. Buprenorphine, a partial mu-opioid agonist, is an alternative treatment for opioid dependence but has not been extensively studied in pregnancy.MethodsWe conducted a double-blind, double-dummy, flexible-dosing, randomized, controlled study in which buprenorphine and methadone were compared for use in the comprehensive care of 175 pregnant women with opioid dependency at eight international sites. Primary outcomes were the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, the length of the hospital stay for neonates, and neonatal head circumference.ResultsTreatment was discontinued by 16 of the 89 women in the methadone group (18%) and 28 of the 86 women in the buprenorphine group (33%). A comparison of the 131 neonates whose mothers were followed to the end of pregnancy according to treatment group (with 58 exposed to buprenorphine and 73 exposed to methadone) showed that the former group required significantly less morphine (mean dose, 1.1 mg vs. 10.4 mg; P<0.0091), had a significantly shorter hospital stay (10.0 days vs. 17.5 days, P<0.0091), and had a significantly shorter duration of treatment for the neonatal abstinence syndrome (4.1 days vs. 9.9 days, P<0.003125) (P values calculated in accordance with prespecified thresholds for significance). There were no significant differences between groups in other primary or secondary outcomes or in the rates of maternal or neonatal adverse events.ConclusionsThese results are consistent with the use of buprenorphine as an acceptable treatment for opioid dependence in pregnant women. (Funded by the National Institute on Drug Abuse; ClinicalTrials.gov number, NCT00271219.).

Dataset Information

Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey.

Publications

Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey.

Similar Datasets

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