The ACT NOW Clinical Practice Survey:  Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s):  Jessica Snowden, Akshatha, Robert Annett, et al

What was done?

In the fall of 2017, 54 sites within two research networks were surveyed.  The sites were asked about the protocols and practices they used to treat NOWS infants.  They were also asked how NOWS infants were diagnosed, what drugs they were given, what non-drug methods were used, and what areas of the hospital cared for NOWS infants.

What was found?

Sites could be divided into those that were NICUs (neonatal intensive care units) and those that were not ICUs (non-ICUs).  NICUs were more likely to have protocols for screening mothers and diagnosing NOWs.  They were also more likely to have protocols for how to give drugs for NOWS symptoms and encouraging breastfeeding.  NICUs were more likely to use non-drug methods to treat NOWS infants.

Non-drug methods included swaddling, cuddling, massage, and low-stimulation environments.  Morphine was the first drug of choice for NOWS symptoms at a majority of sites, regardless of their type.

What do the results mean?

Non-ICU sites need targeted training and standardized care plans for NOWS infants.  However, it is not clear which practices are the most beneficial.  Some variations in care may be best for some NOWS infants.  The long-term effects of drug therapy and non-drug methods in these infants are unknown.  The variations seen in this study show the need for multisite clinical trials in infants with NOWS.  These studies will help define the best policies and practices to use with NOWS infants.

Why was this study conducted?

Neonatal opioid withdrawal syndrome (NOWS) often occurs when the mothers of unborn babies use opioids.  The number of babies with NOWS has dramatically increased in the last 10 years due to the opioid crisis in the US.  Doctors and hospitals have developed standard protocols on how best to care for these babies.  The goal of this study was to collect information on how hospitals care for NOWS infants and to use this information for future clinical studies on the best methods to care for them.

Appreciation:

The authors especially thank the sites of the Institutional Development Award States Pediatric Clinical Trials Network and the Neonatal Research Network for contributing participating in the survey.  The authors would also like to thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

You may learn more about this publication here:  https://www.ncbi.nlm.nih.gov/pubmed/31324654

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.