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Rooming-in for Infants at Risk for Neonatal Abstinence Syndrome: Outcomes 5 Years following Its Introduction as the Standard of Care at One Hospital
Objective The practice of rooming-in for opioid-dependent infants was introduced as the standard of care at our hospital following a pilot study which demonstrated that such infants had shorter lengths of stay and were less likely to require pharmacological treatment. We sought to determine whether these benefits have continued, and whether outcomes support continuing to use rooming-in as standard care.
Study Design Opioid-dependent infants delivered at 36 weeks gestation or later between January 1, 2015, and December 31, 2019, were eligible for rooming-in. Charts were reviewed and data were extracted regarding maternal and infant conditions, whether neonatal pharmacological treatment was required, and total length of hospital stay. Outcomes were compared with two historical groups reported in a previous pilot study: 24 healthy near-term opioid-dependent newborns who were admitted directly to the neonatal intensive care unit (NICU) prior to the introduction of rooming-in (May 1, 2012–May 31, 2013), and 20 similar opioid-dependent infants who were the first to room-in at our hospital (September 1, 2013–September 30, 2014).
Results Only 3.5% of 57 infants who roomed-in during the 5-year study period required pharmacological treatment, compared with 15% who roomed-in during the first year of the program's introduction and 83.3% who had been admitted directly to the NICU. The median length of stay remained 5 days for infants rooming-in, compared with 24 days for opioid-dependent infants in the cohort admitted to the NICU.
Conclusion Early observations of the benefits of rooming-in on neonatal outcomes were sustained. Infants allowed to room-in were significantly less likely to require initiation of pharmacotherapy and a prolonged hospital stay than similar infants prior to the implementation of rooming-in as standard care. A large proportion of the infants who might have benefited from rooming-in required admission to the NICU for reasons other than neonatal abstinence syndrome (NAS).
Benefits of rooming-in for near-term opioid-dependent infants were sustained or increased.
Rooming-in is sustainable as standard care for these newborns.
Many infants required admission to NICU for reasons other than NAS.
Keywordsneonatal abstinence syndrome - opioid use disorder - nonpharmacological treatment - opioid-dependent infants
Received: 03 June 2020
Accepted: 24 September 2020
17 November 2020 (online)
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid-related Harms in Canada. Ottawa: Public Health Agency of Canada; March 2020. Accessed August 1, 2020 at: https://health-infobase.canada.ca/substance-related-harms/opioids
- 2 Orpana HM, Lang JJ, Baxi M. et al. Tendances canadiennes en matière de mortalité liée aux opioïdes et d’invalidité découlant d’un trouble de consommation d’opioïdes, à la lumière de l’Étude sur la charge mondiale de morbidité (1990–2014). Health Promot Chronic Dis Prev Can 2018; 38 (06) 234-243
- 3 Dawson E, Lew J, Mauer-Vakil D, Van Dijk A, Belanger P, Moore KM. A longitudinal analysis of temporal and spatial incidence of neonatal abstinence syndrome in Ontario: 2003-2016. J Opioid Manag 2019; 15 (03) 205-212
- 4 MacMillan KDL. Neonatal abstinence syndrome: review of epidemiology, care models, and current understanding of outcomes. Clin Perinatol 2019; 46 (04) 817-832
- 5 Stanford Children's Health. Neonatal Abstinence Syndrome. May 2020. Available at: https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387 “https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387”. Accessed August 1, 2020
- 6 Murphy-Oikonen J, Montelpare WJ, Southon S, Bertoldo L, Persichino N. Identifying infants at risk for neonatal abstinence syndrome: a retrospective cohort comparison study of 3 screening approaches. J Perinat Neonatal Nurs 2010; 24 (04) 366-372
- 7 Maguire DJ, Taylor S, Armstrong K. et al. Long-term outcomes of infants with neonatal abstinence syndrome. Neonatal Netw 2016; 35 (05) 277-286
- 8 Cairns PA. Drug misuse: conception into childhood. Curr Paediatrics 2001; 11 (06) 475-479
- 9 Hunt RW, Tzioumi D, Collins E, Jeffery HE. Adverse neurodevelopmental outcome of infants exposed to opiate in-utero. Early Hum Dev 2008; 84 (01) 29-35
- 10 Pritham UA, Paul JA, Hayes MJ. Opioid dependency in pregnancy and length of stay for neonatal abstinence syndrome. J Obstet Gynecol Neonatal Nurs 2012; 41 (02) 180-190
- 11 Filteau J, Coo H, Dow K. Trends in incidence of neonatal abstinence syndrome in Canada and associated healthcare resource utilization. Drug Alcohol Depend 2018; 185: 313-321
- 12 United Nations Children's Fund & World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternaity and newborn services: the revised BABY-FRIENDLY HOSPITAL INITIATIVE. 2018 . Accessed August 1, 2020 at: https://apps.who.int/iris/bitstream/handle/10665/272943/9789241513807-eng.pdf?sequence=19&isAllowed=y
- 13 Cleveland Clinic. Rooming-in: rest is healing. January 1, 2018. Accessed August 1, 2020 at: https://my.clevelandclinic.org/health/articles/15275-rooming-in-rest-is-healing
- 14 Davies GA, Newman A, Newton L. et al. Maternal satisfaction with rooming-in to reduce neonatal abstinence syndrome (poster). BJOG Int J Obstet Gynaecol 2015; 122 (S2): 265-266
- 15 Abrahams RR, Kelly SA, Payne S, Thiessen PN, Mackintosh J, Janssen PA. Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physician 2007; 53 (10) 1722-1730
- 16 Saiki T, Lee S, Hannam S, Greenough A. Neonatal abstinence syndrome--postnatal ward versus neonatal unit management. Eur J Pediatr 2010; 169 (01) 95-98
- 17 Hodgson ZG, Abrahams RR. A rooming-in program to mitigate the need to treat for opiate withdrawal in the newborn. J Obstet Gynaecol Can 2012; 34 (05) 475-481
- 18 Hünseler C, Brückle M, Roth B, Kribs A. Neonatal opiate withdrawal and rooming-in: a retrospective analysis of a single center experience. Klin Padiatr 2013; 225 (05) 247-251
- 19 Newman A, Davies GA, Dow K. et al. Rooming-in care for infants of opioid-dependent mothers: Implementation and evaluation at a tertiary care hospital. Can Fam Physician 2015; 61 (12) e555-e561
- 20 Holmes AV, Atwood EC, Whalen B. et al. Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics 2016; 137 (06) e20152929
- 21 McKnight S, Coo H, Davies G. et al. Rooming-in for infants at risk of neonatal abstinence syndrome. Am J Perinatol 2016; 33 (05) 495-501
- 22 Grossman MR, Berkwitt AK, Osborn RR. et al. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics 2017; 139 (06) e20163360
- 23 Howard MB, Schiff DM, Penwill N. et al. Impact of parental presence at infants' bedside on neonatal abstinence syndrome. Hosp Pediatr 2017; 7 (02) 63-69
- 24 Wachman EM, Grossman M, Schiff DM. et al. Quality improvement initiative to improve inpatient outcomes for neonatal abstinence syndrome. J Perinatol 2018; 38 (08) 1114-1122
- 25 Lembeck AL, Tuttle D, Locke R. et al. Outcome differences in neonates exposed in-utero to opioids managed in the NICU versus the pediatric floor. J Addict Med 2019; 13 (01) 75-78
- 26 Cree M, Jairath P, May O. A hospital-level intervention to improve outcomes of opioid exposed newborns. J Pediatr Nurs 2019; 48: 77-81
- 27 MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB, Volpe Holmes A. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review and meta-analysis. JAMA Pediatr 2018; 172 (04) 345-351
- 28 Coyle MG, Brogly SB, Ahmed MS, Patrick SW, Jones HE. Neonatal abstinence syndrome. Nat Rev Dis Primers 2018; 4 (01) 47
- 29 Wachman EM, Schiff DM, Silverstein M. Neonatal abstinence syndrome: advances in diagnosis and treatment. JAMA 2018; 319 (13) 1362-1374
- 30 MacVicar S, Kelly LE. Systematic mixed-study review of nonpharmacological management of neonatal abstinence syndrome. Birth 2019; 46 (03) 428-438
- 31 Whalen BL, Holmes AV, Blythe S. Models of care for neonatal abstinence syndrome: What works?. Semin Fetal Neonatal Med 2019; 24 (02) 121-132
- 32 Grossman M, Berkwitt A. Neonatal abstinence syndrome. Semin Perinatol 2019; 43 (03) 173-186
- 33 Ryan G, Dooley J, Gerber Finn L, Kelly L. Nonpharmacological management of neonatal abstinence syndrome: a review of the literature. J Matern Fetal Neonatal Med 2019; 32 (10) 1735-1740
- 34 Statistics Canada 2016 Census Profile, Kingston, Ontario. Available at: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/page.cfm?Lang=E&Geo1=CSD&Code1=3510010&Geo2=PR&Code2=35&SearchText=Kingston&SearchType=Begins&SearchPR=01&B1=All&GeoLevel=PR&GeoCode=3510010&TABID=1&type=0 . Accessed May 24, 2020
- 35 Queen's Printer for Ontario. 2014, Southeast Ontario Local Health Integration Network. Available at: http://www.southeastlhin.on.ca . Accessed May 24, 2020
- 36 Kingston Community Health Centres. 2020 . Thrive. Accessed May 24, 2020 at: http://kchc.ca/weller-avenue/thrive
- 37 Hudak ML, Tan RC. Committee on Drugs, Committee on fetus and newborn, American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
- 38 Dow K, Ordean A, Murphy-Oikonen J. et al. Neonatal Abstinence Syndrome Work Group. Neonatal abstinence syndrome clinical practice guidelines for Ontario. J Popul Ther Clin Pharmacol 2012; 19 (03) e488-e506
- 39 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
- 40 Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK. A novel approach to assessing infants with neonatal abstinence syndrome. Hosp Pediatr 2018; 8 (01) 1-6