Snowden Jessica N, Akshatha A, Annett Robert D, Crawford Margaret M, Das Abhik, Devlin Lori A, Higgins Rosemary D, Hu Zhuopei, Lindsay Elizabeth, Merhar Stephanie, Campbell Nesmith Clare, Pratt-Chavez Heather, Ross Judith, Simon Alan E, Smith M Cody, Turley Christine B, Walden Anita, Young Leslie, Whalen Bonny
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas;
Kapiolani Women and Children's Hospital, Honolulu, Hawaii.
Hosp Pediatr. 2019 Aug;9(8):585-592. doi: 10.1542/hpeds.2019-0089. Epub 2019 Jul 19.
The incidence of neonatal opioid withdrawal syndrome (NOWS) has increased fivefold over the last 10 years. Standardized NOWS care protocols have revealed many improved patient outcomes. Our objective for this study is to describe results of a clinical practice survey of NOWS management practices designed to inform future clinical studies in the diagnosis and management of NOWS.
A cross-sectional survey was administered to medical unit directors at 32 Institutional Development Award States Pediatric Clinical Trial Network and 22 Neonatal Research Network sites in the fall of 2017. Results are presented as both the number and percentage of positive responses. Ninety-five percent Wilson confidence intervals (CIs) were generated around estimates, and χ and Fisher's exact tests were used to compare the association between unit type and reporting of each protocol.
Sixty-two responses representing 54 medical centers were received. Most participating NICU and non-ICU sites reported protocols for NOWS management, including NOWS scoring (98% NICU; 86% non-ICU), pharmacologic treatment (92% NICU; 64% non-ICU), and nonpharmacologic care (79% NICU; 79% non-ICU). Standardized protocols for pharmacologic care and weaning were reported more frequently in the NICU (92% [95% CI: 80%-97%] and 94% [95% CI: 83%-98%], respectively) compared with non-ICU settings (64% [95% CI: 39%-84%] for both) ( < .05 for both comparisons). Most medical centers reported morphine as first-line therapy (82%; 95% CI: 69%-90%) and level 3 and level 4 NICUs as the location of pharmacologic treatment (83%; 95% CI: 71%-91%).
Observed variations in care between NICUs and non-ICUs revealed opportunities for targeted interventions in training and standardized care plans in non-ICU sites.
新生儿阿片类药物戒断综合征（NOWS）的发病率在过去10年中增长了五倍。标准化的NOWS护理方案已显示出许多改善的患者预后。本研究的目的是描述一项NOWS管理实践的临床实践调查结果，旨在为未来NOWS诊断和管理的临床研究提供信息。
2017年秋季，对32个机构发展奖州儿科临床试验网络和22个新生儿研究网络站点的医疗单位主任进行了横断面调查。结果以阳性反应的数量和百分比表示。在估计值周围生成95%威尔逊置信区间（CI），并使用χ检验和费舍尔精确检验来比较单位类型与每个方案报告之间的关联。
共收到代表54个医疗中心的62份回复。大多数参与的新生儿重症监护病房（NICU）和非ICU站点报告了NOWS管理方案，包括NOWS评分（NICU为98%；非ICU为86%）、药物治疗（NICU为92%；非ICU为64%）和非药物护理（NICU为79%；非ICU为79%）。与非ICU环境相比，NICU中报告的药物护理和撤药标准化方案更为频繁（分别为92%[95%CI：80%-97%]和94%[95%CI：83%-98%]），而非ICU环境中两者均为64%[95%CI：39%-84%]）（两项比较均P<0.05）。大多数医疗中心报告吗啡为一线治疗药物（82%；95%CI：69%-90%），3级和4级NICU为药物治疗地点（83%；95%CI：71%-91%）。
NICU和非ICU之间观察到的护理差异揭示了在非ICU站点进行针对性培训干预和标准化护理计划的机会。
