Purpose: Neonates suffering from NAS receive NMS to treat withdrawal symptoms associated with this disease. Frequent NMS dosing and close monitoring are required to ensure adequate symptom control and prevent adverse events. Maximum dose achieved, titration, severity of disease, and variance in in-utero exposure to addictive drugs all contribute to length of stay. The primary objective of this drug utilization evaluation is to assess adherence to current institutional guidelines for titrating neonates and infants off NMS and to identify opportunities for improvement to potentially decrease length of stay in this population.
Methods: A retrospective chart review of neonates and infants treated for NAS between July 1, 2012 and June 30, 2013 in the Intensive Care Nursery (ICN) was completed. Data from the electronic medical record system was used to identify 48 patients who received NMS over this period of time. NAS severity was assessed every three to four hours using the modified Finnegan scoring system for all patients in the ICN being treating with NMS. The data collected included: patient date of birth, patient weight, individual and average modified Finnegan scores, scheduled and rescue NMS doses, adjunct medications, missed opportunities to wean, and length of stay. A missed opportunity to wean was defined as a 24-hour average modified Finnegan score less than eight with no corresponding dose reduction. Results will be analyzed using statistical tests to determine if a relationship exists between missed weaning opportunities and overall length of stay. The study was submitted to the Institutional Review Board for approval. All data being collected was de-identified for confidentiality.
Hollinger, Nicole; Hvisdas, Christopher; Samohod, Maria; DeCerbo, Tara E.; Larson, Janet; McKenna, Kristin; and Roke, Lindsey, "Evaluation of the appropriate weaning of neonatal morphine solution (NMS) in the treatment of neonatal abstinence syndrome (NAS) and its effect on length of stay (LOS)" (2013). Pharmacy, Presentations and Grand Rounds. Paper 6. http://jdc.jefferson.edu/jeffpharmacypresgr/6