Abstract
Objective
The rising incidence of neonatal abstinence syndrome (NAS) has amplified the importance
of nonpharmacological interventions in its management, which include the selection
of feedings. With the goal of obtaining an accurate assessment of the effects of current
feeding practices in NAS infants in our neonatal intensive care unit, we conducted
a retrospective review of NAS infants at our hospital over a 3-year period to determine
their nutritional selections and evaluate their length of stay (LOS), length of treatment
(LOT), and growth outcomes.
Study Design
Retrospective chart review of term infants (≥37 weeks of gestation) with NAS. Maternal
and infant demographics and characteristics were recorded. Infants were grouped based
on majority (>50% of total feeding) nutritional selections and LOS, LOT, and growth
parameters were evaluated. Linear regression was used to compare group outcomes. Significance
was set at a p-value <0.05.
Results
A total of 70 infants were included and grouped based on majority feeds into maternal
breast milk (MBM), standard term formula (STF), low lactose formula (LLF), and extensively
hydrolyzed formula (EHF) groups. Feeding selections were provider-dependent and infants
were placed on MBM or STF as an initial selection. In all infants included in our
review, LLF was selected as the first choice following MBM or STF for increased gastrointestinal
(GI) disturbance-related Finnegan Neonatal Abstinence Scoring scores and changed to
EHF if LLF failed to improve the GI-related symptoms. The STF-fed infants had the
shortest LOS, and none of these infants required pharmacological treatment. The LOT
and LOS were similar in the MBM- and LLF-fed groups. Infants who were EHF fed had
the longest LOT and LOS. All feeding groups demonstrated appropriate growth.
Conclusion
Nutritional selections in our NAS infants were modified for the severity of their
withdrawal symptoms. All nutritional modifications driven by severity of withdrawal
symptoms supported favorable growth outcomes in the infants.
Key Points
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Our NAS infants were fed with multiple types of nutrition.
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Infants with severe NAS required more elemental feeds.
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All formula selections supported favorable growth.
Keywords
neonatal abstinence syndrome - opioids - drug withdrawal - nutrition - formula - maternal
breast milk - hydrolyzed formula
