Neonatal Abstinence Syndrome Management From Prenatal Counseling to Postdischarge Follow-up Care: Results of a National Survey

Abstract

Objective: The goal of this study was to assess the current status of neonatal abstinence syndrome management from prenatal counseling to postdischarge follow-up care. Methods: An anonymous electronic survey of 26 questions was sent to the medical directors or charge nurses at 383 NICUs. Contact information was obtained by using the American Medical Association’s FREIDA online database and the 2011 American Hospital Association Guide Book. Responses were gathered by using the SurveyMonkey online portal, which was designed to grant responders 1-time access. Results: There were 179 responses (47%), and 0.6%, 16.2%, and 83.2% identified themselves as level I, level II, and level III units, respectively. Prenatal counseling for at-risk mothers is offered by 56.5% of responders. Written protocols for neonatal abstinence syndrome management were reported by 72.5%. All but 3 institutions used toxicology screening in cases of suspected in utero drug exposure. Formalized scoring is used by 98.7%. Breastfeeding is recommended by 74.1%. Morphine (56.1%), methadone (24.8%), and tincture of opium (12.7%) are the most common first-line agents reported in opiate withdrawal, whereas morphine (51.0%), methadone (19.7%), and phenobarbital (13.6%) are used in polydrug withdrawal. Less than 20% of NICUs use clonidine. Home treatment programs are offered by 34.0% of responders, and long-term developmental follow-up is offered by 71.3%. Conclusions: There is considerable diversity in the management of neonatal abstinence syndrome. Alternative management strategies, including prenatal counseling and home treatment programs, need to be explored to improve overall patient care.