DeAtley Heather N, Burton Amanda, Fraley Michelle DeLuca, Haltom Joan
Inpatient Pharmacy Department, Ephraim McDowell Regional Medical Center, Danville, Kentucky.
Pharmacotherapy. 2017 Jul;37(7):856-860. doi: 10.1002/phar.1966. Epub 2017 Jul 6.
The authors sought to evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. A single-center, retrospective chart review was conducted at a Level II nursery in a community hospital in Kentucky. Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included. The protocol 1 group consisted of 33 neonates who received an initial dose of morphine 0.04 mg/kg/dose administered orally every 4 hours (January 1-December 31, 2014), and the protocol 2 group consisted of 26 neonates who received an initial dose of morphine 0.06 mg/kg/dose administered orally every 3 hours (January 1-November 30, 2015), after a change in the protocol for managing NAS was implemented on January 1, 2015. Data were reviewed and compared between the two protocol groups to determine the impact that the dosage change had on length of hospital stay and morphine treatment duration. The average length of stay decreased by 7 days in the protocol 2 group compared with the protocol 1 group (21 vs 28.65 days). The average duration of treatment decreased by 7 days in the protocol 2 group compared with the protocol 1 group (18.3 vs 25.4 days). These differences between groups were not statistically significant, however, because the population size was not large enough to achieve adequate power. These results indicate that protocol 2 displayed the potential to decrease length of stay and duration of treatment compared with protocol 1 at this facility; however, balancing higher starting doses with the risk of oversedation will continue to challenge the health care team. Concern for oversedation when using the higher starting dose in protocol 2 has prompted further research (e.g., protocol 3, initial morphine 0.05 mg/kg/dose every 3 hrs). Continued research is also necessary with larger patient populations to enable generalizability to other institutions.
作者试图评估在改变新生儿戒断综合征（NAS）管理的机构方案后，吗啡对住院时间和治疗时长的影响，以努力改善患者预后。在肯塔基州一家社区医院的二级保育室进行了一项单中心回顾性病历审查。纳入了2014年1月1日至2015年12月31日期间出生、被诊断为NAS并接受吗啡治疗的59名新生儿。方案1组由33名新生儿组成，他们在2014年1月1日至12月31日期间每4小时口服初始剂量为0.04mg/kg/剂量的吗啡；方案2组由26名新生儿组成，在2015年1月1日实施NAS管理方案变更后，他们在2015年1月1日至11月30日期间每3小时口服初始剂量为0.06mg/kg/剂量的吗啡。对两个方案组的数据进行审查和比较，以确定剂量变化对住院时间和吗啡治疗时长的影响。与方案1组相比，方案2组的平均住院时间减少了7天（21天对28.65天）。与方案1组相比，方案2组的平均治疗时长减少了7天（18.3天对25.4天）。然而，两组之间的这些差异无统计学意义，因为样本量不够大，无法获得足够的检验效能。这些结果表明，在该机构中，与方案1相比，方案2显示出缩短住院时间和治疗时长的潜力；然而，在较高起始剂量与过度镇静风险之间取得平衡将继续给医疗团队带来挑战。在方案2中使用较高起始剂量时对过度镇静的担忧促使了进一步的研究（例如，方案3，初始吗啡剂量为0.05mg/kg/剂量，每3小时一次）。还需要对更多患者群体进行持续研究，以便能够推广到其他机构。
