title: A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome.
abstract: OBJECTIVE
  To compare pharmacologic treatment strategies for neonatal abstinence syndrome (NAS) with respect to total duration of opioid treatment and length of inpatient hospital stay.
  
  
  METHODS
  We conducted a cohort analysis of late preterm and term neonates who received inpatient pharmacologic treatment of NAS at one of 20 hospitals throughout 6 Ohio regions from January 2012 through July 2013. Physicians managed NAS using 1 of 6 regionally based strategies.
  
  
  RESULTS
  Among 547 pharmacologically treated infants, we documented 417 infants managed using an established NAS weaning protocol and 130 patients managed without protocol-driven weaning. Regardless of the treatment opioid chosen, when we accounted for hospital variation, infants receiving protocol-based weans experienced a significantly shorter duration of opioid treatment (17.7 vs. 32.1 days, P < .0001) and shorter hospital stay (22.7 vs. 32.1 days, P = .004). Among infants receiving protocol-based weaning, there was no difference in the duration of opioid treatment or length of stay when we compared those treated with morphine with those treated with methadone. Additionally, infants treated with phenobarbital were treated with the drug for a longer duration among those following a morphine-based compared with methadone-based weaning protocol. (P ≤ .002).
  
  
  CONCLUSIONS
  Use of a stringent protocol to treat NAS, regardless of the initial opioid chosen, reduces the duration of opioid exposure and length of hospital stay. Because the major driver of cost is length of hospitalization, the implications for a reduction in cost of care for NAS management could be substantial.
authors: Perinatal Institute, Cincinnati Children's Hospital, Cincinnati, Ohio; eric.hall@cchmc.org.
authors: Eric S
authors: ES
authors: Hall
authors: Perinatal Institute, Cincinnati Children's Hospital, Cincinnati, Ohio;
authors: Scott L
authors: SL
authors: Wexelblatt
authors: Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio;
authors: Moira
authors: M
authors: Crowley
authors: Department of Neonatology, Akron Children's Hospital, Akron, Ohio;
authors: Jennifer L
authors: JL
authors: Grow
authors: Department of Nursing, Dayton Children's Hospital, Dayton, Ohio;
authors: Lisa R
authors: LR
authors: Jasin
authors: The Research Institute, and.
authors: Mark A
authors: MA
authors: Klebanoff
authors: Department of Neonatology, Nationwide Children's Hospital, Columbus, Ohio;
authors: Richard E
authors: RE
authors: McClead
authors: Perinatal Institute, Cincinnati Children's Hospital, Cincinnati, Ohio;Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio; and.
authors: Jareen
authors: J
authors: Meinzen-Derr
authors: Department of Neonatology, ProMedica Toledo Children's Hospital, Toledo, Ohio.
authors: Vedagiri K
authors: VK
authors: Mohan
authors: Department of Neonatology, ProMedica Toledo Children's Hospital, Toledo, Ohio.
authors: Howard
authors: H
authors: Stein
authors: Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio;
authors: Michele C
authors: MC
authors: Walsh
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy; D057194:Intention to Treat Analysis; D007902:Length of Stay; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009020:Morphine / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009357:Neonatal Abstinence Syndrome / Q000188:drug therapy*; D058850:Opiate Substitution Treatment; D010634:Phenobarbital / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics; D009020:Morphine; D008691:Methadone; D010634:Phenobarbital
keywords: drug withdrawal; methadone; morphine; neonatal abstinence syndrome; opioid; treatment protocol