The effect of standardizing treatment when managing neonatal abstinence syndrome

Abstract

Objective: Standardizing treatment of neonatal abstinence syndrome (NAS) is currently recommended; however, single institution prospective studies are lacking regarding the success of this approach. The study objective was to evaluate overall newborn response and length of stay (LOS) of neonates treated for NAS following the institution of a strict standardized treatment protocol. Methods: From 1 January 2014 to 30 June 2016, a prospective cohort study was performed collecting neonatal outcomes before and after the standardization of a strict NAS morphine weaning treatment protocol. The primary outcome measure was length of stay. The standardized protocol was fully instituted in June 2015. Results: A total of 395 neonates were treated for NAS during the study. The LOS for the 17 months prior to the initiation of this protocol was 23.31 (±6.2) days (233 neonates). The LOS in the 13 months after protocol initiation was 18.17 (±5.1) days (162 neonates). This was a difference of 5.14 days (95%CI 4.0-6.3 days) less in LOS (p < .0001). Conclusions: These data demonstrate that the initiation of a standardized NAS treatment protocol can significantly improve neonatal response and decrease LOS. It is recommended that institutions with nurseries that treat infants with NAS develop standardized treatment protocols to improve care for this complicated patient population.

Keywords: Neonatal abstinence syndrome; neonatal treatment protocols; opiate use disorder in pregnancy; substance abuse in pregnancy.