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Neonatal abstinence syndrome managed by rooming-in with mothers
A decreased need for pharmacologic treatment and shorter length of stay for infants with neonatal abstinence syndrome were associated with treatment using rooming-in with mothers compared with neonatal ICUs, according to a recently published systematic review and meta-analysis.
Neonatal ICUs (NICUs) are typically used to treat opioid-exposed newborns, compared with rooming-in, in which infants and mothers remain together 24 hours a day unless separation is needed for medical or safety reasons, Kathryn Dee L. MacMillan, MD, of the Leadership Preventive Medicine Residency, pediatrics department, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and colleagues reported.
“Our systematic review included studies from the United States, Canada and Europe and covered a range of clinical settings,” MacMillan and colleagues wrote. “Therefore, rooming-in could be effective in diverse settings that manage neonates at risk for [neonatal abstinence syndrome (NAS)]. Our findings are relevant to current practice because implementing rooming-in for opioid-exposed newborns is straightforward and has clear benefits.”
The researchers reviewed Medline, Cinahl, the Cochrane Library and clincialtrials.gov through June 25, 2012, searching for studies assessing rooming-in for opioid-exposed neonates compared with standard NICU care. Dichotomous outcomes were pooled using a random-effects model.
Four hundred and thirteen studies were initially screened, with six included in the meta-analysis. In those six studies, there was “consistent evidence” finding that rooming-in is preferred to NICU care for reducing pharmacotherapy use (RR = 0.37; 95% CI, 0.19-0.71) and length of stay (LOS; weighted mean difference = –10.41 days; 95% CI, –16.84 to –3.98 days).
Rooming-in was preferred in sensitivity analysis resolving heterogeneity for the use of pharmacotherapy (RR = 0.32; 95% CI, 0.18-0.57).
Although inpatient costs were lower with rooming-in compared with NICU in three studies, quantitative analysis was precluded by significant heterogeneity, according to the researchers.
Rooming-in also was supported over NICU for increased breast-feeding rates and discharge home to families, according to qualitative analysis.
Higher readmission rates or in-hospital adverse events were not related to rooming-in.
“There is consistent evidence supporting rooming-in as an effective strategy for managing NAS by reducing the need for pharmacotherapy and decreasing LOS,” the researchers concluded. “In clinical care settings where it is safe and feasible, we recommend that rooming-in be considered as a preferred management strategy for opioid-exposed newborns and for newborns with NAS.”
Disclosures: The authors report no relevant financial disclosures.
