Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal.
Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal.
复制标题
新生儿阿片类药物戒断的饮食、睡眠、安慰方法或常规护理。
DOI：
10.1056/nejmoa2214470
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Walsh,Michele
中科院分区：
文献类型：
--
作者：
Young,LeslieW;Ounpraseuth,SongthipT;Merhar,StephanieL;Hu,Zhuopei;Simon,AlanE;Bremer,AndrewA;Lee,JeannetteY;Das,Abhik;Crawford,MargaretM;Greenberg,RachelG;Smith,PBrian;Poindexter,BrendaB;Higgins,RosemaryD;Walsh,Michele
尽管临床医生传统上使用Finnegan新生儿戒断评分工具来评估新生儿阿片类药物戒断的严重程度，但一种新的基于功能的方法--饮食、睡眠、控制台护理方法--正在越来越多地使用。新的方法是否可以安全地减少时间，直到婴儿在医学上准备出院时，它是广泛应用于不同sites.MethodsIn这个群集随机，对照试验在26家美国医院，我们招募了新生儿阿片类药物戒断综合征的婴儿谁出生在36周的妊娠或以上。在随机指定的时间，医院从使用Finnegan工具的常规护理过渡到Eat，Sleep，Console方法。在3个月的过渡期内，对每家医院的工作人员进行了使用新方法的培训。主要结局是从出生到试验定义的出院医疗准备就绪的时间。在出生后的前3个月内评估的复合安全性结果包括住院安全性，计划外的医疗保健访问，和非意外的创伤或death.ResultsA共1305名婴儿参加。在一项意向性治疗分析中，纳入了837名符合出院医学准备的婴儿，从出生到出院准备的天数在饮食，睡眠，控制组为8.2天，在常规护理组为14.9天（校正后的平均差异，6.7天; 95%置信区间[CI]，4.7至8.8），率比为0.55（95%CI，0.46至0.65; P<0.001）。不良后果的发生率是相似的，在两个groups.ConclusionsAs与平时的护理相比，使用的吃，睡眠，控制台护理的方法显着减少的天数，直到新生儿阿片类药物戒断综合征的婴儿在医学上准备出院，而不增加指定的不良后果。（由美国国立卫生研究院的帮助结束成瘾长期（HEAL）倡议资助; ESC-NOW ClinicalTrials.gov编号，NCT 04057820。
BackgroundAlthough clinicians have traditionally used the Finnegan Neonatal Abstinence Scoring Tool to assess the severity of neonatal opioid withdrawal, a newer function-based approach — the Eat, Sleep, Console care approach — is increasing in use. Whether the new approach can safely reduce the time until infants are medically ready for discharge when it is applied broadly across diverse sites is unknown.MethodsIn this cluster-randomized, controlled trial at 26 U.S. hospitals, we enrolled infants with neonatal opioid withdrawal syndrome who had been born at 36 weeks’ gestation or more. At a randomly assigned time, hospitals transitioned from usual care that used the Finnegan tool to the Eat, Sleep, Console approach. During a 3-month transition period, staff members at each hospital were trained to use the new approach. The primary outcome was the time from birth until medical readiness for discharge as defined by the trial. Composite safety outcomes that were assessed during the first 3 months of postnatal age included in-hospital safety, unscheduled health care visits, and nonaccidental trauma or death.ResultsA total of 1305 infants were enrolled. In an intention-to-treat analysis that included 837 infants who met the trial definition for medical readiness for discharge, the number of days from birth until readiness for hospital discharge was 8.2 in the Eat, Sleep, Console group and 14.9 in the usual-care group (adjusted mean difference, 6.7 days; 95% confidence interval [CI], 4.7 to 8.8), for a rate ratio of 0.55 (95% CI, 0.46 to 0.65; P<0.001). The incidence of adverse outcomes was similar in the two groups.ConclusionsAs compared with usual care, use of the Eat, Sleep, Console care approach significantly decreased the number of days until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes. (Funded by the Helping End Addiction Long-term (HEAL) Initiative of the National Institutes of Health; ESC-NOW ClinicalTrials.gov number, NCT04057820.)
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