title: Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study.
abstract: OBJECTIVE
  To evaluate the generalizability of stringent protocol-driven weaning in improving total duration of opioid treatment and length of inpatient hospital stay after treatment of neonatal abstinence syndrome (NAS).
  
  
  METHODS
  We conducted a retrospective cohort analysis of 981 infants who completed pharmacologic treatment of NAS with methadone or morphine from January 2012 through August 2014. Before July 2013, 3 of 6 neonatology provider groups (representing Ohio's 6 children's hospitals) directed NAS nursery care by using group-specific treatment protocols containing explicit weaning guidelines. In July 2013, a standardized weaning protocol was adopted by all 6 groups. Statistical analysis was performed to identify effects of adoption of the multicenter weaning protocol on total duration of opioid treatment and length of hospital stay at the protocol-adopting sites and at the sites with preexisting protocol-driven weaning.
  
  
  RESULTS
  After adoption of the multicenter protocol, infants treated by the 3 groups previously without stringent weaning guidelines experienced shorter duration of opioid treatment (23.0 vs 34.0 days, P < .001) and length of inpatient hospital stay (23.7 vs 31.6 days, P < .001). Protocol-adopting sites also experienced a lower rate of adjunctive drug therapy (5% vs 21%, P = .004). Outcomes were sustained by the 3 groups who initially had specific weaning guidelines after multicenter adoption (duration of treatment = 17.0 days and length of hospital stay = 23.3 days).
  
  
  CONCLUSIONS
  Adoption of a stringent weaning protocol resulted in improved NAS outcomes, demonstrating generalizability of the protocol-driven weaning approach. Opportunity remains for additional protocol refinement.
authors.affiliation: Perinatal Institute, and eric.hall@cchmc.org.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hall
authors.affiliation: Perinatal Institute, and.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Wexelblatt
authors.affiliation: Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio;
authors.forename: Moira
authors.initials: M
authors.lastname: Crowley
authors.affiliation: Pediatrix Medical Group of Ohio, Akron Children's Hospital, Akron, Ohio;
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Grow
authors.affiliation: Department of Nursing, Dayton Children's Hospital, Dayton, Ohio;
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Jasin
authors.affiliation: The Research Institute, and.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Klebanoff
authors.affiliation: Department of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Richard E
authors.initials: RE
authors.lastname: McClead
authors.affiliation: Perinatal Institute, and Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio;
authors.forename: Jareen
authors.initials: J
authors.lastname: Meinzen-Derr
authors.affiliation: Department of Neonatology, ProMedica Toledo Children's Hospital, Toledo, Ohio.
authors.forename: Vedagiri K
authors.initials: VK
authors.lastname: Mohan
authors.affiliation: Department of Neonatology, ProMedica Toledo Children's Hospital, Toledo, Ohio.
authors.forename: Howard
authors.initials: H
authors.lastname: Stein
authors.affiliation: Pediatrics, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio;
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000627:therapeutic use; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000628:therapy*; D009293:Opioid-Related Disorders / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008691:Methadone