A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome.
A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome.
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DOI：
10.1542/hpeds.2017-0128
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Berkwitt, Adam K
中科院分区：
文献类型：
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作者：
Grossman, Matthew R;Lipshaw, Matthew J;Berkwitt, Adam K
新生儿禁欲综合征（NAS）是一个日益严重的问题，对卫生保健系统造成了重大负担。传统的Finnegan新生儿戒断评分系统（FNASS）评估方法可能导致NAS婴儿不必要的阿片类药物治疗。我们开发了一种新的评估方法，并描述其对NAS.METHODS婴儿管理的影响：我们回顾性比较了耶鲁纽黑文儿童医院住院部管理的50例连续阿片类药物暴露婴儿的治疗决定。所有婴儿每2至6小时记录一次FNASS评分，但使用Eat，Sleep，Console（ESC）评估方法进行管理。将使用ESC方法做出的实际治疗决策与基于记录的FNASS评分的预测治疗决策进行比较。主要结果是出生后用吗啡治疗。结果：通过使用ESC方法，6名婴儿（12%）用吗啡治疗，与使用FNASS方法预测的31名婴儿（62%）用吗啡治疗相比（P <0.001）。ESC方法在8天（2.7%）开始或增加吗啡，而使用FNASS方法预测为76天（25.7%）（P <.001）。有没有再入院或不良事件reported.CONCLUSIONS：婴儿管理使用ESC的方法与吗啡治疗的频率显着低于他们会通过使用FNASS的方法。ESC方法是管理NAS婴儿的有效方法，限制了药物治疗，并可能导致住院时间大幅缩短。
OBJECTIVES: Neonatal abstinence syndrome (NAS) is a growing problem and poses a significant burden on the health care system. The traditional Finnegan Neonatal Abstinence Scoring System (FNASS) assessment approach may lead to unnecessary opioid treatment of infants with NAS. We developed a novel assessment approach and describe its effect on the management of infants with NAS.METHODS: We retrospectively compared treatment decisions of 50 consecutive opioid-exposed infants managed on the inpatient unit at the Yale New Haven Children's Hospital. All infants had FNASS scores recorded every 2 to 6 hours but were managed by using the Eat, Sleep, Console (ESC) assessment approach. Actual treatment decisions made by using the ESC approach were compared with predicted treatment decisions based on recorded FNASS scores. The primary outcome was postnatal treatment with morphine.RESULTS: By using the ESC approach, 6 infants (12%) were treated with morphine compared with 31 infants (62%) predicted to be treated with morphine by using the FNASS approach (P < .001). The ESC approach started or increased morphine on 8 days (2.7%) compared with 76 days (25.7%) predicted by using the FNASS approach (P < .001). There were no readmissions or adverse events reported.CONCLUSIONS: Infants managed by using the ESC approach were treated with morphine significantly less frequently than they would have been by using the FNASS approach. The ESC approach is an effective method for the management of infants with NAS that limits pharmacologic treatment and may lead to substantial reductions in length of stay.