NICU, pharmacologic use for opioid-exposed neonates declined post-AAP guidelines
Click Here to Manage Email Alerts
Key takeaways:
- Long and costly hospitalizations can occur for neonatal opioid withdrawal syndrome.
- NICU and pharmacologic use decreased in hospitals using AAP guidelines.
Pharmacologic treatment and NICU use declined for infants exposed to opioids in the womb following the publication of related guidelines from the AAP, according to a study published in Pediatrics.
The AAP published guidelines for the management of neonatal opioid withdrawal syndrome (NOWS) in late 2020, recommending nonpharmacologic treatment as the first-line approach, unless pharmacologic treatment is needed for severe NOWS.
In parallel with the broader opioid epidemic, the incidence of opioid exposure in neonates has increased over time and been associated with “long and costly” hospitalizations, according to one of the authors of the new study.
“There's a lot of variation in how these babies are treated,” Carly E. Milliren, MPH, a biostatistician in the Institutional Centers for Clinical and Translational Research at Boston Children’s Hospital, told Healio.
“We were familiar with the guidelines that the AAP released in 2020 that recommended strategies for managing babies with NOWS and were interested to see how these guidelines change practice at pediatric hospitals,” Milliren said.
Milliren and colleagues studied data on 824 newborns with NOWS from 11 hospitals — 434 before the guidelines and 390 post-guidelines. They found that use of pharmacologic treatment was significantly lower in the post-guidelines period (50.3%) vs. the pre-guidelines period (59%). Additionally, NICU admission was significantly lower in the post-guidelines period (46.7%) vs. the pre-guideline period (78.6%), with an immediate decrease (beta = 23.0%; P < .001) and a decrease over time in the post-guidelines period (beta = 0.7% per month; P = .03).
Most hospitals reduced pharmacologic treatment (8 of 11; 73%) and NICU use (10 of 11; 91%) post-guidelines.
“We were really impressed to find such a dramatic drop in the NICU utilization for this population,” Milliren said. “We found a nearly 25% reduction immediately after the guidelines were published, followed by an even further reduction month over month after.”
Length of stay, though, was virtually unchanged, which Milliren said she and her colleagues “weren’t surprised by” because it is “a hard measure to alter.”
“There are a lot of factors that go into it, including whether they were getting pharmacologic treatment, need for discharge planning, and in this particular population, involvement of social services can contribute to longer stays,” Milliren said.
She said the findings indicate there is still an opportunity for improvement to better align care with the guidelines.
“One way that hospitals could do that is adopting policies or standardized pathways that are aligned with the guidelines to further reduce use of the NICU or reduce pharmacologic treatment use, especially the use of opioids to limit postnatal opioid exposure,” Milliren said.
Collapse
Read more about
Click Here to Manage Email Alerts