Development & Implementation of a Neonatal Abstinence Syndrome Protocol

Abstract

Purpose: The purpose of this project is to implement a Neonatal Abstinence Syndrome (NAS) protocol at Nebraska Medicine in Omaha, NE with the use of Buprenorphine and to educate all Neonatal Intensive Care Unit (NICU) staff on the use of the Finnegan Neonatal Abstinence Scoring Tool (FNAST).|Background: The incidence of NAS has increased drastically over the past fifteen years and has become a national epidemic.|Setting: The population utilized is all infants who are at risk of NAS or diagnosed with NAS that are admitted into the NICU at Nebraska Medical Center.|Methods: An educational program for all NICU staff was implemented utilizing inter-observer reliability instrument to ensure accuracy of scoring and assessing infant's at risk of withdrawal. A NAS protocol was developed for the use of Buprenorphine and put into place on November 7, 2017.|Results: Data was compared between infants diagnosed with NAS and treated with methadone in 2017 compared to those infants treated with buprenorphine in 2018. After nursing education was completed, inter-observer reliability was achieved 96.5% of the time Finnegan Scoring was performed. The average LOS in 2017 was 32 days for the infants that were treated with Methadone. The average LOS for those treated with buprenorphine in 2018 was 20 days. The average LOT in 2017 was 34 days and was 14 days in 2018.|Conclusion: A new protocol with stringent training of staff in the use of the Finnegan Scoring tool will lead to a more accurate assessment of NAS infants and documentation of withdrawal symptoms and a more reliable weaning regimen. Although there is limited data, utilizing buprenorphine as first line pharmacological treatment has shown to decrease both length of stay and length of treatment. Additional studies are needed to continue to compare buprenorphine with other first line medications currently being used.