Introduction
Methods
Results
Assessment
Reference | Index vs. reference group(s) | Scale | Primary results |
---|---|---|---|
Finnegan, 1975[29] | 37 infants assessed with NASS vs. 37 infants born prior to development of NASS | Neonatal Narcotic Abstinence Scoring System | Mean inter-rater reliability coefficient: 0.82 (0.75–0.96) |
Exposure methadone and heroin | 20 items, weighted on pathologic severity | Management of NAS without drug Rx: 30% vs. 46% | |
LOS: 6 days vs. 8 days | |||
Total Rx days decreased by 25% | |||
Lipsitz, 1975[31] | 41 infants evaluated by 2 pediatric residents, placed in 5 groups, one group which was opioid exposed | Narcotic Withdrawal Score | Only the infants exposed to opioids had scores ≥ 5; concluded that a score > 4 suggests a clinical threshold for Rx |
Exposure methadone and heroin | 11 items, scored 0–3 based on severity | ||
Green, 1981[32] | Infants exposed to methadone or heroin(n = 50) | Neonatal Narcotic Withdrawal Index | Inter-rater reliability coefficient: 0.771* |
Control infants (n = 40) | 7 items, scored 0–2 based on severity | Mean NAS score on day 2 of life: 1.57 vs. 3.08* | |
7th item is “other” and includes 12 other symptoms | |||
Zahorodny, 1998[33] | Group A: opioid-exposed infants with NAS (n = 30) | Neonatal Withdrawal Inventory | Group A: inter-rater reliability coefficient: 0.89–0.98 |
Group B: opioid infants with NAS (n = 12) and nonopioid-exposed controls (n = 13) | 8 items given predetermined weights | Group B: sensitivity and specificity for NAS diagnosis: 100%, 100% | |
Group C: opioid-exposed infants with NAS (n = 25) | Group C: sensitivity and specificity for Rx threshold vs. the NASS: 100%, 100% | ||
Jones, 2010[3] | 131 opioid-exposed infants, scored using the same scale | MOTHER NAS scale (modified Finnegan) | Intraclass correlation coefficient > 0.94 |
Exposure methadone or buprenorphine |
Nonpharmacologic interventions
Infant feeding method
Reference | Study design | Study objective | Index vs. reference group(s) | Assessment tool | Results |
---|---|---|---|---|---|
Abdel-Latif, 2006[38] | Retrospective Cohort | To determine association between breastfeeding and NAS outcomes | Breastfed infants with NAS (n = 85) | Finnegan Score | Rx for NAS: OR = 0.36 (CI 0.18–0.71)* |
Formula-fed infants with NAS (n = 105) | Mean LOS: 14.7 (SD 14.9) vs. 19.1 (SD 15.0) days* | ||||
Dryden, 2009[42] | Retrospective Cohort | To determine association between breastfeeding and NAS outcomes | Breastfed infants with NAS (n = 99) | Modified Lipsitz | Rx for NAS: OR = 0.55 (CI 0.34–0.88)* |
Formula-fed infants with NAS (n = 351) | |||||
McQueen, 2011[39] | Retrospective Cohort | To determine association between breastfeeding and NAS outcomes | Breastfed infants with NAS (n = 8) | Modified Finnegan | Mean # of NAS scores: 25.0 (SD 23.5) vs. 56.2 (SD 39.1) vs. 95.6 (SD 34.6)* |
Combination-fed infants with NAS (n = 11) | Mean NAS score 4.9 (SD 2.9) vs. 6.5 (SD 3.7) vs. 6.9 (SD 4.2)* | ||||
Formula-fed infants with NAS (n = 9) | |||||
Pritham, 2012[43] | Retrospective Cohort | To determine association between breastfeeding and NAS outcomes | Breastfed with NAS (n = 14) | Not specified | Mean LOS: -3.3 (SE 1.7) days |
Infants combination-fed with NAS (n = 22) | |||||
Formula-fed infants with NAS (n = 96) | |||||
O’Connor, 2013[40] | Case Series | To describe association between breastfeeding and NAS outcomes | Breastfed infants with NAS (n = 65) | Modified Finnegan | Mean NAS score: 8.83 (SD 3.56) vs. 9.65 (SD 2.58) |
Formula-fed infants with NAS (n = 20) | Rx for NAS: 23.1% vs. 30.0% | ||||
Wachman, 2013[9] | Prospective Cohort | To determine association of genetic variables with NAS outcomes | Breastfed infants with NAS (n = 38) | Modified Finnegan | Rx for NAS: 50% vs. 77%* |
Formula-fed infants with NAS (n = 48) | Mean LOS: 15.8 (CI 11.5–20.1) vs. 27.4 (CI 22.5–32.3) days* | ||||
Welle-Strand, 2013[41] | Ambi-directional Cohort | To determine association between breastfeeding and NAS | Breastfed infants with NAS (n = 95) | Modified Finnegan | Rx for NAS: 53% vs. 80%* |
outcomes | Formula-fed infants with NAS (n = 29) | Mean length of Rx: 28.6 (SD 19.1) vs. 46.7 (SD 26.3) days* | |||
Hunseler, 2013[44] | Retrospective Cohort | To describe association between rooming-in and NAS outcomes | NAS infants exposed to rooming-in (n = 24) | Finnegan | Finnegan Score > 12: 6.3% vs. 6.4% |
Control NAS infants (n = 53) | Rx for NAS: 79.2% vs. 88.7% | ||||
Mean length of Rx: 27 vs. 32.5 days | |||||
Mean LOS: 38 vs. 41.5 days | |||||
Abrahams, 2007[45] | Retrospective Cohort | To describe association between rooming-in and NAS outcomes | Infants with NAS exposed to rooming-in (n = 32) | Modified Finnegan | Mean length of Rx: 5.9 vs. 18.6 days*; 5.9 vs. 18.6 days* |
Control infants with NAS (n = 38) (historical comparison) | Mean LOS: 11.8 vs. 23.5 days; 11.8 vs. 25.9 days* | ||||
Control infants with NAS (n = 36) (from another institution) | |||||
D’Apolito, 1999[46] | Nonblinded Random Assignment of Rx | To determine the association between infants sleeping in a rocking bed vs. controls with NAS outcomes | Infants with NAS exposed to rocking bed (n = 7) | Finnegan | Mean NAS score on day 7 of intervention: 10.2 (SD 2.1) vs. 8.0 (SD 1.8) |
Control infants with NAS (n = 7) | |||||
Oro, 1988[47] | Randomized Assignment of Rx with Matched Controls | To determine the association between infants sleeping in a waterbed vs. controls and NAS outcomes | Infants with NAS exposed to a waterbed (n = 15) | Finnegan | Maximum NAS score: 6.2 (SD 0.7) vs. 6.4 (SD 1.0) |
Control infants with NAS (n = 15) | Mean LOS: 10.5 (SD 1.2) vs. 11.5 (SD 3.4) days | ||||
Maichuk, 1999[48] | Randomized to Intervention; Nurses Blinded to Hypothesis | To determine the association between sleeping position with NAS outcomes | Infants with NAS placed in prone position (n = 25) | Finnegan | Maximum NAS score: 10.52 (SD 2.08) vs. 13.17 (SD 2.03)* |
Infants with NAS placed in the supine position (n = 23) | Mean NAS score: 5.11 (SD 0.64) vs. 7.60 (SD 0.70)* | ||||
Filippelli, 2012[49] | Case Series | To describe the possible effects of NIA on infants with NAS | Infants with NAS exposed to NIA (n = 54) | Not applicable | Chart review revealed improvements in calming, sleep, and feeding |
Other nonpharmacologic interventions
Pharmacologic management
Reference | Design | Purpose | Comparison (Index vs. Reference) | Assessment measure | Primary outcome | Results |
---|---|---|---|---|---|---|
Jackson, 2004[50] | Double-blind RCT | Efficacy of opioid vs. phenobarbitone as first-line therapy | Morphine (n = 41) Phenobarbitone (n = 34) | Lipsitz | Mean length of Rx | 8 vs. 12 days* (unadjusted) |
Langenfeld, 2005[51] | Randomized Trial, Blinding Not Specified | Compare tincture of opium to oral morphine | Morphine (n = 17) | Finnegan | Mean length of Rx | 29.8 vs. 26.9 days |
Tincture of Opium (n = 16) | Mean LOS | 37.5 vs. 32.4 days | ||||
Kraft, 2008[52] | Phase I, Randomized, Open Label, Active Control | Feasibility and safety of buprenorphine in Rx of NAS | Buprenorphine (n = 13) | Modified Finnegan | Mean length of Rx | 22 (SD 12) vs. 32 (SD 16) days |
Neonatal opium solution (n = 13) | Mean LOS | 27 (SD 11) vs. 38 (SD 13) days | ||||
Kraft, 2011[53] | Phase I, Randomized, Open Label, Active Control | Feasibility and safety of buprenorphine | Buprenorphine (n = 12) | Modified Finnegan | Mean length of Rx | 23 vs. 38 days* |
Morphine (n = 12) | Mean LOS | 23 vs. 42 days | ||||
Coyle, 2002[54] | Partially Randomized, Controlled Trial | Assess whether Rx with DTO + phenobarbital vs. DTO alone is better | DTO + phenobarbital (n = 10) | Finnegan | Finnegan Scores | Infants in placebo group, spent more time with FS > 7 * |
DTO + placebo (n = 10) | Infants in phenobarbital group spent more time with FS < 5* | |||||
Mean LOS | Mean: 38 vs. 79 days* | |||||
Agthe, 2009[55] | Randomized, Double-Blinded Controlled Trial | To assess use of clonidine as an adjunct therapy to opioids to manage NAS | Clonidine (n = 40) | Modified Finnegan | Mean length of Rx | 11 (95% CI 8–15) vs. 15 (95% CI 12–17) days |
Placebo (n = 40) | ||||||
Surran, 2013[56] | Randomized, Nonblinded Controlled Trial | Clonidine versus phenobarbital to reduce # days of Rx with morphine sulfate | Phenobarbital (n = 34) | Modified Finnegan | Length of Rx with morphine sulfate | B = -4.6 days (95% CI 0.3–8.9)* |
Clonidine (n = 32) |