Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Neonatal abstinence syndrome practice variations across pediatric subspecialty

Journal of Perinatology volume 41, pages 1512–1514 (2021)Cite this article

Subjects

From 2018 to 2019, the Section on Neonatal-Perinatal Medicine (SONPM) Trainees and Early Career Neonatologists within the American Academy of Pediatrics organized a national advocacy campaign titled ‘Navigating NAS’ [1], aimed to raise awareness on topics surrounding neonatal abstinence syndrome (NAS). A 10-question survey was created and distributed to members of SONPM, the Section on Hospital Medicine, and the Section on Pediatric Trainees. We hypothesized wide variation exists in the inpatient and follow-up referral practices for infants with NAS across pediatric subspecialty (neonatal intensive care unit (NICU) vs. non-NICU) due to the shift in the care of infants with NAS from the NICU to non-NICU units in recent years [2].

The survey was completed by 244 respondents (1.3% response rate), 73.7% of whom were NICU clinicians. Respondents represented 113 institutions across the United States (US). Most infants with NAS not requiring medication (NAS-No-Tx) were cared for on non-NICU floors (77.6%), while most infants with NAS requiring medication (NAS-Tx) were cared for in the NICU (75.3%). However, NICU subspecialists selected NICU location more frequently than non-NICU subspecialists (25.3% vs. 14.5% for NAS-No-Tx; 83.2% vs. 54.5% for NAS-Tx, respectively). NICU and non-NICU subspecialists selected morphine as the most common first-line medication (82.8 vs. 85.9%, p = 0.26), and clonidine as the most common second-line medication (41.0 vs. 42.2%, p = 0.11). Only 30.3% of respondents stated there was a follow-up program for infants with NAS-No-Tx, and 58.6% stated a follow-up program existed for infants with NAS-Tx. Statewide/early intervention (EI) was the most common referral program for NAS-No-Tx (44.6%), while the NICU follow-up clinic was the most common program for NAS-Tx (41.3%). However, NICU subspecialists referred infants with NAS-No-Tx similarly to EI and NICU clinics (40.0 and 32.0%), while non-NICU subspecialists referred them primarily to EI (54.2%) (p = 0.04) (Table 1). NICU subspecialists primarily referred infants with NAS-Tx to NICU clinics, while non-NICU subspecialists primarily referred to EI (48.1 vs. 51.4%, p < 0.01). Approximately half (52.1%) reported follow-up ≤6 months, while only 4.8% had follow-up beyond 3 years, with no difference between NICU and non-NICU subspecialists (p = 0.17) (Table 2). Physicians were identified as the primary referral source by both NICU and non-NICU subspecialists (48.1 vs. 42.4%).

Table 1 Post-discharge referral practice stratified by the need for medication and pediatric subspecialty.
Full size table
Table 2 Post-discharge follow-up duration and referral source.
Full size table

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Navigating NAS American Academy of Pediatrics. https://www.aap.org/en-us/about-the-aap/aap-press-room/campaigns/navigating-nas/Pages/default.aspx. Accessed 28 July 2020.

  2. Lembeck AL, Tuttle D, Locke R, Lawler L, Jimenez P, Mackely A, et al. Outcome differences in neonates exposed in-utero to opioids managed in the NICU versus pediatric floor. J Addict Med. 2019;13:75–8.

    Article  CAS  Google Scholar 

  3. Hall ES, McAllister JM, Wexelblatt SL. Developmental disorders and medical complications among infants with subclinical intrauterine opioid exposure. Popul Health Manag. 2019;22:19–24.

    Article  Google Scholar 

  4. Oei JL, Melhuish E, Uebel H, Azzam N, Breen C, Burns L, et al. Neonatal abstinence syndrome and high school performance. Pediatrics. 2017;139:e20162651.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Tufts Medical Center, Boston, MA, USA

    Elizabeth Yen

  2. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    Heidi J. Murphy

  3. Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA

    Hayley Friedman

  4. Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA

    Ashley M. Lucke

  5. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    Angie Mae Rodday

Authors
  1. Elizabeth Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidi J. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hayley Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley M. Lucke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angie Mae Rodday
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth Yen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yen, E., Murphy, H.J., Friedman, H. et al. Neonatal abstinence syndrome practice variations across pediatric subspecialty. J Perinatol 41, 1512–1514 (2021). https://doi.org/10.1038/s41372-020-00831-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-00831-8

Search

Advanced search

Quick links