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Murphy K, Coo H, Warre R, et al. Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey. Paediatr Child Health. 2017;22(3):148-152doi: 10.1093/pch/pxx054.
Murphy, K., Coo, H., Warre, R., Shah, V., & Dow, K. (2017). Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey. Paediatrics & child health, 22(3), 148-152. https://doi.org/10.1093/pch/pxx054
Murphy, Katie, et al. "Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey." Paediatrics & child health vol. 22,3 (2017): 148-152. doi: https://doi.org/10.1093/pch/pxx054
Murphy K, Coo H, Warre R, Shah V, Dow K. Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey. Paediatr Child Health. 2017 Jun;22(3):148-152. doi: 10.1093/pch/pxx054. Epub 2017 May 15. PMID: 29479202; PMCID: PMC5804777.
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Paediatr Child Health. 2017 Jun;22(3):148-152. doi: 10.1093/pch/pxx054. Epub 2017 May 15.

Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey.

Paediatrics & child health

Katie Murphy, Helen Coo, Ruth Warre, Vibhuti Shah, Kimberly Dow

Affiliations

  1. Department of Pediatrics, Queen's University, Kingston, Ontario.
  2. Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario.
  3. Department of Pediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.

PMID: 29479202 PMCID: PMC5804777 DOI: 10.1093/pch/pxx054

Abstract

BACKGROUND: There are no evidence-based national guidelines for managing neonatal abstinence syndrome (NAS) and surveys from other countries have demonstrated considerable variations in practice.

OBJECTIVE: To describe NAS management practices in Canada.

METHOD: The directors of all Level 2 and Level 3 neonatal intensive care units (NICUs) were contacted to request their participation in a structured telephone survey. Frequency distributions were generated and associations between practice variations and unit type (Level 2 or 3) and size were examined.

RESULTS: Personnel at 65 of 103 sites (63.1%) participated. Most (92.3%) stated their hospital has a written NAS practice guideline. The majority (89.5%) use a version of Finnegan's scoring system to monitor signs. If pharmacological treatment is required, 89.2% admit infants to the NICU and 93.8% routinely use cardiorespiratory monitors when treatment is initiated. Morphine is the first-line medication at most sites (96.9%). There was greater variability in terms of other practices: 44.6% observe at-risk infants in the NICU, while 52.3% allow them to room-in with their mothers; 65.1% use adjunct medications; 36.9% and 38.9% will discharge infants on the first-line and adjunct medications respectively, and 53.8% reported that breastfeeding is always encouraged, while 44.6% discourage breastfeeding if the mother continues to use illicit drugs and 1.5% make recommendations on an individual basis. Few practice variations were associated with unit type or size.

CONCLUSION: While most NICUs surveyed have an NAS practice guideline, there are some notable differences in how NAS is managed. This underscores the need for research that can be translated into best practices.

Keywords: Canada; Infant; Management; Neonatal abstinence syndrome; Neonatal intensive care unit; Newborn.

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