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Management of neonates exposed prenatally to opioids: Impact of a developmental care program implementation
Gilles Cambonie1, Lison Aujogues Dit Baron2, Clementine Combes2
1Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France; Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France.
Insights
Implementing a developmental care program significantly increased non-pharmacological care (NPC) for infants with prenatal opioid exposure. This led to reduced medication use and shorter hospital stays, improving neonatal opioid withdrawal syndrome (NOWS) management.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Pharmacology
Background:
- Traditional management of neonates with prenatal opioid exposure relies on pharmacotherapy (PT).
- Emerging non-pharmacological care (NPC) approaches lack evidence for widespread implementation.
- The study aimed to evaluate the impact of a developmental care program on managing these infants.
Purpose of the Study:
- To assess the impact of a formalized developmental care program on the management of infants with in utero opioid exposure.
- To evaluate changes in the utilization of non-pharmacological care (NPC) and pharmacotherapy (PT).
- To determine the effect on length of hospital stay (LOS) and neonatal opioid withdrawal syndrome (NOWS) occurrence.
Main Methods:
- Observational study in a tertiary perinatal center comparing three 6-year periods (2003-2020).
- Data collected included admission to the parents-infant unit (PIU), exposure to NPC and PT, NOWS, LOS, and feeding type.
- Intervention impact measured by comparing outcomes across the three periods before, during, and after program implementation and consolidation.
Main Results:
- Exposure to NPC increased significantly (37% to 84%, p < 0.001) from the first to the third period.
- Exposure to PT (40% to 15%, p = 0.002) and LOS (13 to 8 days, p = 0.003) decreased significantly.
- Hospitalization in PIU and the later study period were associated with the absence of PT.
Conclusions:
- An active policy supporting NPC training and practice is crucial for managing infants with prenatal opioid exposure.
- Implementation of a developmental care program effectively reduced medication usage and length of hospitalization.
- NPC is a vital component in improving outcomes for neonates exposed to opioids in utero.
Background:
Traditional approaches to management of neonates prenatally exposed to opioids are based on the use of pharmacotherapy (PT), adjusted to evolution of infant symptoms. Newer approaches focused on non-pharmacological care (NPC) are emerging, but there is little evidence on the active policies to implement to ensure their widespread practice. The primary objective of the study was to assess whether the implementation of a developmental care program in our neonatal medicine department had an impact on the management of these infants during hospitalization, notably exposure to NPC.
Method:
Observational study in a tertiary perinatal center. Data collected during hospitalization for infants with in utero opioid exposure included admission in the parents-infant unit (PIU) of the maternity ward, exposure to NPC and PT, occurrence of neonatal opioid withdrawal syndrome (NOWS), length of hospital stay (LOS) and feeding type at discharge. The impact of the intervention was measured by comparing three 6-year periods, the first preceding the implementation of a formalized developmental care program (2003-2008); the second following implementation of the program (2009-2014); the third after consolidation of the program (2015-2020).
Results:
258 infants prenatally exposed to opioid were recorded. From the first to the third period, admission rate in the PIU was comparable (68 % to 73 %, p = 0. 95). Exposure to NPC (37 % to 84 %, p < 0.001) increased, whereas exposure to PT (40 % to 15 %, p = 0.002) and LOS (13 [9-18] days to 8 [6-11] days, p = 0.003) decreased. NOWS occurred in 141 (55 %) infants (63 % to 47 %, p = 0.10). In these infants, decrease in PT was also observed (64 % to 34 %, p = 0.02). After adjustment for perinatal confounders, hospitalization in the PIU (OR 3.23 [1.36; 7.66]; p = 0.008), and the 2015-2020 period (OR 5.11 [2.06; 12.64]; p = 0.004) were associated with absence of PT.
Conclusions:
An active policy, supporting the training and warranting the practice of NPC, is essential to reduce medication usage and length of hospitalization in infants exposed in utero to opioids.
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