Abstract | OBJECTIVES: METHODS: We conducted a retrospective cohort analysis of 981 infants who completed pharmacologic treatment of NAS with methadone or morphine from January 2012 through August 2014. Before July 2013, 3 of 6 neonatology provider groups (representing Ohio' s 6 children's hospitals) directed NAS nursery care by using group-specific treatment protocols containing explicit weaning guidelines. In July 2013, a standardized weaning protocol was adopted by all 6 groups. Statistical analysis was performed to identify effects of adoption of the multicenter weaning protocol on total duration of opioid treatment and length of hospital stay at the protocol-adopting sites and at the sites with preexisting protocol-driven weaning. RESULTS: After adoption of the multicenter protocol, infants treated by the 3 groups previously without stringent weaning guidelines experienced shorter duration of opioid treatment (23.0 vs 34.0 days, P < .001) and length of inpatient hospital stay (23.7 vs 31.6 days, P < .001). Protocol-adopting sites also experienced a lower rate of adjunctive drug therapy (5% vs 21%, P = .004). Outcomes were sustained by the 3 groups who initially had specific weaning guidelines after multicenter adoption ( duration of treatment = 17.0 days and length of hospital stay = 23.3 days). CONCLUSIONS: Adoption of a stringent weaning protocol resulted in improved NAS outcomes, demonstrating generalizability of the protocol-driven weaning approach. Opportunity remains for additional protocol refinement.
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Authors | Eric S Hall, Scott L Wexelblatt, Moira Crowley, Jennifer L Grow, Lisa R Jasin, Mark A Klebanoff, Richard E McClead, Jareen Meinzen-Derr, Vedagiri K Mohan, Howard Stein, Michele C Walsh, OCHNAS Consortium |
Journal | Pediatrics
(Pediatrics)
Vol. 136
Issue 4
Pg. e803-10
(Oct 2015)
ISSN: 1098-4275 [Electronic] United States |
PMID | 26371196
(Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2015 by the American Academy of Pediatrics. |
Chemical References |
- Analgesics, Opioid
- Morphine
- Methadone
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Topics |
- Adult
- Analgesics, Opioid
(administration & dosage, therapeutic use)
- Clinical Protocols
- Cohort Studies
- Female
- Humans
- Infant, Newborn
- Length of Stay
- Male
- Methadone
(administration & dosage, therapeutic use)
- Morphine
(administration & dosage, therapeutic use)
- Neonatal Abstinence Syndrome
(therapy)
- Opioid-Related Disorders
(therapy)
- Retrospective Studies
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