Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study
Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study
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DOI：
10.1542/peds.2015-1141
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发表时间：
2015-10-01
期刊：
影响因子：
8
通讯作者：
Walsh, Michele C.
中科院分区：
文献类型：
--
作者：
Hall, Eric S.;Wexelblatt, Scott L.;Walsh, Michele C.
目的：评估严格的方案驱动的断奶在改善阿片类药物治疗的总抽象时间和新生儿戒断综合征（NAS.METHODS）治疗后住院时间的普遍性：我们对2012年1月至2014年8月期间使用美沙酮或吗啡完成NAS药物治疗的981名婴儿进行了回顾性队列分析。在2013年7月之前，6个儿科提供者团体中的3个（代表俄亥俄州的6家儿童医院）通过使用包含明确断奶指南的团体特定治疗方案指导NAS托儿所护理。2013年7月，所有6个组均采用了标准化断奶方案。进行统计分析以确定采用多中心撤机方案对阿片类药物治疗总持续时间和方案采用地点和预先存在方案驱动撤机地点的住院时间的影响。多中心方案通过后，3组婴儿在没有严格的断奶指南的情况下接受阿片类药物治疗的时间较短（23.0 vs 34.0天，P < .001）和住院时间（23.7 vs 31.6天，P < .001）。采用方案的研究中心也经历了较低的连续药物治疗率（5% vs 21%，P = 0.004）。结果是由3组谁最初有具体的撤机指南后，多中心通过（治疗持续时间= 17.0天，住院时间= 23.3天）。结论：通过严格的撤机协议导致改善NAS的结果，证明协议驱动的撤机方法的普遍性。仍有机会进一步完善方案。
OBJECTIVES: To evaluate the generalizability of stringent protocol-driven weaning in improving total abstract duration of opioid treatment and length of inpatient hospital stay after treatment of neonatal abstinence syndrome (NAS).METHODS: We conducted a retrospective cohort analysis of 981 infants who completed pharmacologic treatment of NAS with methadone or morphine from January 2012 through August 2014. Before July 2013, 3 of 6 neonatology provider groups (representing Ohio's 6 children's hospitals) directed NAS nursery care by using group-specific treatment protocols containing explicit weaning guidelines. In July 2013, a standardized weaning protocol was adopted by all 6 groups. Statistical analysis was performed to identify effects of adoption of the multicenter weaning protocol on total duration of opioid treatment and length of hospital stay at the protocol-adopting sites and at the sites with preexisting protocol-driven weaning.RESULTS: After adoption of the multicenter protocol, infants treated by the 3 groups previously without stringent weaning guidelines experienced shorter duration of opioid treatment (23.0 vs 34.0 days, P < .001) and length of inpatient hospital stay (23.7 vs 31.6 days, P < .001). Protocol-adopting sites also experienced a lower rate of adjunctive drug therapy (5% vs 21%, P = .004). Outcomes were sustained by the 3 groups who initially had specific weaning guidelines after multicenter adoption (duration of treatment = 17.0 days and length of hospital stay = 23.3 days).CONCLUSIONS: Adoption of a stringent weaning protocol resulted in improved NAS outcomes, demonstrating generalizability of the protocol-driven weaning approach. Opportunity remains for additional protocol refinement.