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American Academy of Pediatrics
Article

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

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 and Michele C. Walsh
Pediatrics October 2015, 136 (4) e803-e810; DOI: https://doi.org/10.1542/peds.2015-1141
Eric S. Hall
aPerinatal Institute, and
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Scott L. Wexelblatt
aPerinatal Institute, and
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Moira Crowley
bPediatrics, University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University, Cleveland, Ohio;
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Jennifer L. Grow
cPediatrix Medical Group of Ohio, Akron Children’s Hospital, Akron, Ohio;
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Lisa R. Jasin
dDepartment of Nursing, Dayton Children’s Hospital, Dayton, Ohio;
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Mark A. Klebanoff
eThe Research Institute, and
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Richard E. McClead
fDepartment of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio; and
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Jareen Meinzen-Derr
aPerinatal Institute, and
gBiostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, Ohio;
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Vedagiri K. Mohan
hDepartment of Neonatology, ProMedica Toledo Children’s Hospital, Toledo, Ohio
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Howard Stein
hDepartment of Neonatology, ProMedica Toledo Children’s Hospital, Toledo, Ohio
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Michele C. Walsh
bPediatrics, University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University, Cleveland, Ohio;
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Abstract

OBJECTIVES: To evaluate the generalizability of stringent protocol-driven weaning in improving total duration of opioid treatment and length of inpatient hospital stay after treatment of neonatal abstinence syndrome (NAS).

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.

  • Accepted July 21, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 136, Issue 4
1 Oct 2015
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Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study
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
Pediatrics Oct 2015, 136 (4) e803-e810; DOI: 10.1542/peds.2015-1141

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Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study
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
Pediatrics Oct 2015, 136 (4) e803-e810; DOI: 10.1542/peds.2015-1141
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