Boucher, Jennifer, PharmD

Lai, Andrew, MS2

Meyer, Andrew, MD

Philpot, Patrick, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTAn Outpatient Methadone Weaning Protocol by aNeonatal Intensive Care Unit for NeonatalAbstinence Syndrome (Poster).Andrew Lai MS2USF MCOM- LVHN Campus, Andrew.Lai@lvhn.orgPatrick Philpot DOLehigh Valley Health Network, Patrick.Philpot@lvhn.orgJennifer Boucher PharmDLehigh Valley Health Network, Jenny.Boucher@lvhn.orgAndrew Meyer MDLehigh Valley Health Network, andrew_s.meyer@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtLai, A., Philpot, P., Boucher, J., Meyer, A. (2015, July 16). An Outpatient Methadone Weaning Protocol by a Neonatal Intensive Care Unitfor Neonatal Abstinence Syndrome. Poster presented at The Prologue II Presentation Day University of South Florida,Tampa, FL.Introduction:  Neonatal Abstinence Syndrome (NAS): neonatal withdrawal symptoms as a result of perinatal exposure to drugs, especially opiates, during pregnancy.  The rate of NAS has increased by 300% in the United States since the 1980’s1.    NAS treatment costs reaches as high as $112.6 million dollars per year, the majority of which was heavily influenced by extended hospital stays2.  Inpatient management using traditional strategies of care has led to a length of stay (LOS) range of 8-105 days with a median of 25-34 days3,4,5.   Oei et al 20016 found that inpatient LOS was decreased with the establishment of an outpatient clinic designed specifically for managing NAS patients.   The Neonatal Intensive Care Unit (NICU) at Lehigh Valley Health Network (LVHN) has adopted an outpatient methadone weaning protocol to treat NAS patients with the goal of limiting readmissions and decreasing inpatient length of stay.  Plan:  Characterize patients with NAS, describe the current practices used at LVHN to treat infants with NAS, assess outcome variables at LVHN.  Acknowledgments: We would like to thank Claire Kukielka, MS, CPHQ, Clinical Quality Specialist, for her assistance in the data inquiry. Do:  All term newborns (>37 weeks Estimated Gestational Age) at Lehigh Valley Hospital - Cedar Crest (LVH-CC) between 1/1/2010 and 12/31/2014, admitted to LVH-CC, with an ICD-9 co-diagnosis of NAS at discharge were examined  Data collected via electronic medical records independently by at least two investigators   Exclusion criteria: treatment for NAS with medications other than opioids, an EGA less than 37 weeks at birth, congenital anomalies, iatrogenic NAS due to opiate administration while in the NICU, or infants of multiple gestation.  Act / Conclusions:  The establishment of a clear management protocol for infants discharged from the NICU for NAS has many advantages.  It has been shown to increase opportunities for maternal-infant pair bonding due to shorter hospital stays and increased rates of breastfeeding7.    Abdel-Latif et al. 20028 found that the role of breastfeeding in the outpatient management of NAS led to reduced withdrawal severity, delayed onset of NAS, and decreased need for pharmacologic treatment.   Backes et al 20129 calculated that patients in combined inpatient-to-outpatient management plan saved on average $13,817 in hospital costs per patient compared to a traditional, inpatient-only management strategy.  Next Steps: develop clinical pathway, compare cost savings Andrew Lai, MPH1, Patrick Philpot, DO2, Jennifer Boucher, JD, PharmD2, Andrew Meyer, MD, MBA1,3 University of South Florida Morsani College of Medicine, Tampa, FL1 Division of Neonatology3, Department of Pediatrics2, Lehigh Valley Health Network, Allentown, PA Literature cited: 1. Jones H, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med. 2010; 363:2320–31. 2. American Academy of Pediatrics (AAP) The Committee on Drugs and the Committee on the Fetus and Newborn. Neonatal Drug Withdrawal. Pediatrics. 2012; DOI: 10.1542/peds..2011-3212. 3. Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: Factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG. 2009; 116:665–71. 4. Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005; 5:265–72.     5. Svikis CS, Golden AS, Huggins GR, Pickens RW, McCaul ME, Velez ML, et al. Cost-effectiveness of treatment for drug-abusing pregnant women. Drug Alcohol Depend. 1997; 45:105–13. 6. Oei, J.,Feller, JM, and K Lui. Coordinated Outpatient Care of the Narcotic-dependent Infant. J. Paediatr. Child Health. 2001. 37: 266-270. 7. Isemann B, Meinzen-Derr J, Akinibi H. Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol. 2011; 31:25– 29. 8. Abdel-Latif, ME, Pinner, J, Clews, S, Cooke, F, Lui, K, and J Oei. Effects of Breast Milk on the Severity and Outcome of Neonatal Abstinence Syndrome Among Infants of Drug-Dependent Mothers. Pediatrics. 2006. 117:1163 9. Backes, CH, Backes, CR, Gardner, D, Nankervis, CA, Giannone, PJ, and L Cordero. Neonatal Abstinence Syndrome (NAS): Transitioning Methadone Treated Infants from an Inpatient to an Outpatient Setting. J Perinatol. 2012. 32(6):425-430.   Study / Results:  Figure 1: Inpatient Methadone Weaning Protocol. For infants with Finnegan Scores >8, additional steps are taken such as supplementation with high-calorie formula and vestibular stimulation. Table 1: Secondary Patient Outcomes. There were 56 patients identified that met inclusion/exclusion criteria. ◄ Figure 2: Patient Characteristics. (A) Patient sex. (B) Patient race. There were no African-American patients. (C) Primary payer. (D) Oral fluids received. Figure 4: Readmissions Rate. There were two 30-day readmissions in this group, with only one related to NAS. The first patient was readmitted in 2013 for neonatal drug withdrawal symptoms 11 days after initial discharge and was later discharged 16 days after readmission.   ◄ Figure 3: Common Co-Diagnoses. Most diagnoses were not given to more than one patient.  ► Figure 3: Commonly Prescribed Medication. Morphine p.r.n. was needed in 71.43% of the patients. 

An Outpatient Methadone Weaning Protocol by a Neonatal Intensive Care Unit for Neonatal Abstinence Syndrome (Poster).

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An Outpatient Methadone Weaning Protocol by a Neonatal Intensive Care Unit for Neonatal Abstinence Syndrome (Poster).

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