Department of Pediatrics, Division of Neonatology, Christiana Care Health System, Newark, DE (ALL, DT, RL, LL, PJ, AM, DAP); Sidney Kimmel School of Medicine at Thomas Jefferson University, Philadelphia, PA (ALL, DT, RL, DAP).
J Addict Med. 2019 Jan/Feb;13(1):75-78. doi: 10.1097/ADM.0000000000000455.
The aim of the study is to determine length of stay and length of treatment in infants with neonatal abstinence syndrome (NAS) in the neonatal intensive care unit (NICU) compared to those in the pediatric floor.
Retrospective cohort of infants ≥34 weeks gestation admitted with diagnosis of NAS at a single regional perinatal referral center from July 2014 to October 2015. A standardized NAS protocol for both the NICU and pediatric floor, which included guidelines for the initiation of oral morphine, escalation, and weaning, was followed. Initial location of treatment, NICU or pediatric floor, was determined by physiological stability following birth. Statistical analysis included 1-way analysis of variance and chi-square. Multivariable analysis was performed using generalized linear models to account for confounding.
The study included 235 infants, 80 (34%) were cared for in the NICU. Infants in the NICU had a longer length of stay (27.1 ± 19.1 vs 14.2 ± 10.2 days, P < 0.01), and length of pharmacological treatment (18.0 ± 19.9 vs 9.0 ± 10.2 days, P < 0.01) compared to those on the pediatric floor, respectively. Forty-seven infants were transferred from the NICU to the pediatric floor for the remainder of their hospital stay with a mean time on the pediatric floor of 17.4 ± 14.5 days. After controlling for confounding, admission to the NICU was associated with an increased length of treatment of 12.6 days (95% confidence interval 8.3-16.8) and length of stay of 12.3 days (95% confidence interval 7.9-16.6).
In our population, admission to the pediatric floor compared to the NICU was associated with a shorter length of stay, and a shorter length of pharmacological treatment. Our data suggest that caring for infants with NAS outside of the NICU setting has the potential to improve short-term outcomes and reduce associated costs.
本研究旨在比较新生儿戒断综合征（NAS）婴儿在新生儿重症监护病房（NICU）和儿科病房的住院时间和治疗时间。
本研究为回顾性队列研究，纳入 2014 年 7 月至 2015 年 10 月在某区域性围产医学中心住院、诊断为 NAS 的胎龄≥34 周的婴儿。NICU 和儿科病房均采用标准化的 NAS 方案，包括口服吗啡起始、升级和停药指南。出生后根据生理稳定性确定初始治疗部位（NICU 或儿科病房）。统计分析包括单因素方差分析和卡方检验。采用广义线性模型进行多变量分析，以校正混杂因素。
本研究共纳入 235 例婴儿，80 例（34%）在 NICU 接受治疗。NICU 组的住院时间（27.1±19.1 天比 14.2±10.2 天，P＜0.01）和药物治疗时间（18.0±19.9 天比 9.0±10.2 天，P＜0.01）均长于儿科病房组。47 例婴儿从 NICU 转至儿科病房继续治疗，平均在儿科病房的时间为 17.4±14.5 天。校正混杂因素后，入住 NICU 与治疗时间延长 12.6 天（95%置信区间 8.3-16.8）和住院时间延长 12.3 天（95%置信区间 7.9-16.6）相关。
在本研究人群中，与 NICU 相比，儿科病房入院与住院时间和药物治疗时间更短相关。我们的数据表明，在 NICU 以外的环境中治疗 NAS 婴儿有可能改善短期结局并降低相关成本。
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