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

Jessica N Snowden1, A Akshatha2, Robert D Annett3

  • 1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; jsnowden@uams.edu.

Hospital Pediatrics
|July 21, 2019
PubMed

Insights

Neonatal opioid withdrawal syndrome (NOWS) management varies between NICUs and non-ICUs. Standardized protocols are more common in NICUs, highlighting opportunities for improved care in non-ICU settings for NOWS patients.

Area of Science:

  • Neonatal care
  • Clinical practice surveys
  • Pharmacology

Background:

  • The incidence of neonatal opioid withdrawal syndrome (NOWS) has risen significantly over the past decade.
  • Standardized care protocols have demonstrated improved patient outcomes in NOWS management.

Purpose of the Study:

  • To survey current clinical practices for managing NOWS.
  • To identify variations in NOWS management across different medical units.
  • To inform future research in NOWS diagnosis and treatment.

Main Methods:

  • A cross-sectional survey was distributed to directors of medical units at 32 Institutional Development Award States Pediatric Clinical Trial Network and 22 Neonatal Research Network sites.
  • Data were analyzed to determine the number and percentage of positive responses for various NOWS protocols.
  • Statistical tests (χ², Fisher's exact) were used to compare protocol adoption between unit types.

Main Results:

  • Most centers reported protocols for NOWS scoring, pharmacologic treatment, and non-pharmacologic care.
  • Standardized pharmacologic care and weaning protocols were more frequent in Neonatal Intensive Care Units (NICUs) than non-ICUs (92% vs. 64%).
  • Morphine was the primary first-line therapy (82%), with NICUs (Level 3 and 4) being the main sites for pharmacologic treatment (83%).

Conclusions:

  • Significant variations in NOWS care exist between NICUs and non-ICU settings.
  • Non-ICU sites present opportunities for targeted interventions to standardize NOWS care plans and training.
  • Further research and standardized approaches are needed to optimize NOWS management across all settings.
Abstract

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