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Hosp Pediatr. 2019 Aug;9(8):585-592. doi: 10.1542/hpeds.2019-0089. Epub 2019 Jul 19.

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome.

Author information

1
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; jsnowden@uams.edu.
2
Kapiolani Women and Children's Hospital, Honolulu, Hawaii.
3
University of Mississippi Medical Center, Jackson, Mississippi.
4
RTI International, Research Triangle Park, North Carolina.
5
Department of Pediatrics, University of Louisville, Louisville, Kentucky.
6
College of Health and Human Services, George Mason University, Fairfax, Virginia.
7
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
8
Department of Pediatrics, Section of Neonatology, Tulane University, New Orleans, Louisiana.
9
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
10
Health Sciences Center, University of New Mexico, Albuquerque, New Mexico.
11
Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
12
Environmental Influences on Child Health Outcomes Program, National Institutes of Health, Bethesda, Maryland.
13
West Virginia University Medical Center, Morgantown, West Virginia.
14
Department of Pediatrics, College of Medicine, University of South Carolina, Columbia, South Carolina.
15
University of Vermont Medical Center, Burlington, Vermont; and.
16
Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

OBJECTIVES:

The incidence of neonatal opioid withdrawal syndrome (NOWS) has increased fivefold over the last 10 years. Standardized NOWS care protocols have revealed many improved patient outcomes. Our objective for this study is to describe results of a clinical practice survey of NOWS management practices designed to inform future clinical studies in the diagnosis and management of NOWS.

METHODS:

A cross-sectional survey was administered to medical unit directors at 32 Institutional Development Award States Pediatric Clinical Trial Network and 22 Neonatal Research Network sites in the fall of 2017. Results are presented as both the number and percentage of positive responses. Ninety-five percent Wilson confidence intervals (CIs) were generated around estimates, and χ2 and Fisher's exact tests were used to compare the association between unit type and reporting of each protocol.

RESULTS:

Sixty-two responses representing 54 medical centers were received. Most participating NICU and non-ICU sites reported protocols for NOWS management, including NOWS scoring (98% NICU; 86% non-ICU), pharmacologic treatment (92% NICU; 64% non-ICU), and nonpharmacologic care (79% NICU; 79% non-ICU). Standardized protocols for pharmacologic care and weaning were reported more frequently in the NICU (92% [95% CI: 80%-97%] and 94% [95% CI: 83%-98%], respectively) compared with non-ICU settings (64% [95% CI: 39%-84%] for both) (P < .05 for both comparisons). Most medical centers reported morphine as first-line therapy (82%; 95% CI: 69%-90%) and level 3 and level 4 NICUs as the location of pharmacologic treatment (83%; 95% CI: 71%-91%).

CONCLUSIONS:

Observed variations in care between NICUs and non-ICUs revealed opportunities for targeted interventions in training and standardized care plans in non-ICU sites.

PMID:
31324654
PMCID:
PMC6663517
DOI:
10.1542/hpeds.2019-0089

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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