Neonatal Abstinence Syndrome Project



The Neonatal Intervention Group has identified Neonatal Withdrawal, also called prenatal substance exposure syndrome (PSES), as its initial point of emphasis, having a very large impact in Utah for both women and newborns.

Neonatal Withdrawal includes both neonatal withdrawal from opiate drugs (neonatal abstinence syndrome (NAS), as well as CNS irritability symptoms from discontinuation of maternal benzodiazepines and barbiturates, stimulants (cocaine, amphetamines), SSRIs/SSNRIs, marijuana, tobacco or alcohol. In a recent prevalence survey in Utah(2), 6.8% of umbilical cord samples were positive for one or more substances of abuse. Opiates were the most frequent (4.7%). Also noted were barbiturates, benzodiazepines, alcohol, marijuana, methamphetamine, and cocaine.

In the past, each hospital within the state has had individual approaches to identifying newborns at risk for withdrawal. Over the past year and a half, the University of Utah and the Intermountain Healthcare Women's, Pediatric and Neonatal substance abuse teams have been meeting regularly and have standardized algorithms for identification of the drug-exposed newborn, "sensitive care" to minimize symptoms of withdrawal and CNS irritability, use of a Neonatal Withdrawal Inventory (NWI) score to identify newborns in need of medication for NAS, a standardized oral morphine treatment schedule as well as adjunctive medication therapies for those newborns not weaning from morphine or those with CNS hyperirritability following exposure to multiple classes of maternal medications.

The Neonatal Intervention Group has agreed to adopt and implement the University of Utah-Intermountain Healthcare Neonatal Withdrawal program and offer it to participating sites, it is available here.

Methods:

  • Identify participating hospitals and establish baseline outcomes of at least NAS length of stay for opiate exposed babies and length of stay because of CNS irritability for stimulant, marijuana, or SSRIs/SSNRIs for each participating hospital.
  • Create a data collection and reporting tool that will collect basic patient level and hospital data regarding drug-exposure identification, highest severity (NWI) score, application of "sensitive care", use of narcotic therapy and adjunctive pharmacologic therapy.
  • Complete education in all participating hospitals, and begin use of identification, severity scoring, "sensitive care", narcotic therapy and adjunctive pharmacologic therapy protocols.
  • Create educational materials and seminars for providers and patients regarding the NAS Project. Hold local seminars at each participating hospital to educate providers on a local level.
  • Utilize Rapid Cycle Improvement (PDSA) teams to adjust the program for individual hospital environments.

Goals:

  • UWNQC Neonatal Withdrawal Program will be used to treat at least 80% of eligible drug-exposed infants in participating hospitals.
  • For patients who require treatment with medications for withdrawal or cerebral hyperirritability, length-of-stay will be reduced by at least 1 day when compared to the baseline length-of-stay.

Neonatal Abstinence Syndrome Project Resources