Neonatal Opiate Withdrawal and Rooming-In: A Retrospective Analysis of a Single Center Experience

Abstract

Aims:

To evaluate our treatment of neonatal abstinence syndrome (NAS), our experience with rooming-in of opiate-dependent mothers and to examine the influence of rooming-in on short term outcome of infants exposed to opiates in utero.

Method:

Retrospective analysis of maternal and perinatal data of newborn infants with NAS treated between 2004 and 2011 in a level 3 academic children’s hospital in a German metropolis. Therapy of NAS and duration of therapy, length of hospital stay and costs were considered in particular.

Findings:

Data of 77 newborns with NAS were analysed. 84.6% of infants were treated with tincture of opium (79.2% rooming-in, 88.7% no rooming-in). Infants with rooming-in (n=24) had a 17% shorter median duration of therapy [27.0 d (IQR 24.0–38.5), no rooming-in (n=53) 32.5 d (IQR 25.0–54.5)] and shorter median length of hospital stay [33.0 d (IQR 28.0–48.0), no rooming-in 41.5 d (IQR 30.3–54.5)]. Demographic data was comparable between newborns and mothers with or without rooming-in. Costs were median 13 457 € (IQR 8 967–17 494)/patient [rooming-in: 9 547 € (IQR 7 024–16 135), no rooming-in: 14 486 € (IQR 9 479–19 352)].

Conclusion:

Rooming-in in NAS should be encouraged to shorten duration of therapy and length of hospital stay and thereby reduce costs. No major problems arose in the care of the infants with NAS when parents stayed with their infants but close monitoring of the newborn and strict instruction of parents are required.

Zusammenfassung

Ziel der Studie:

Das neonatale Abstinenz-Syndrom (NAS) soll unter Berücksichtigung des Rooming-in unter Berücksichtigung gesund­heitsökonomischer Aspekte evaluiert werden.

Methode:

Retrospektive Analyse der maternalen und perinatalen Daten der von 2004 – 2011 in der Kinderklinik der Uniklinik Köln behandelten Kinder mit NAS. Berücksichtigt wurden Thera­pie des NAS, Dauer der Therapie, Verweildauer im Krankenhaus und Kosten.

Ergebnisse:

Es wurden die Daten von 77 Neugeborenen mit NAS durch mütterlichen Opiat­konsum ausgewertet, von denen 65 mit Opiumtinktur behandelt wurden. Kinder mit Rooming-in (n = 24) hatten eine um 17 % kürzere Therapiedauer als die Kinder ohne Rooming-in (n = 53) [27,0 d (IQR 24,0–38,5) vs. 32,5 d (IQR 25,0–54,5)] sowie eine kürzere mediane Verweildauer im Krankenhaus [33,0 d (IQR 28,0–48,0) vs. 41,5 d (IQR 30,3–54,5)]. Die demografischen Daten zwischen beiden Gruppen waren vergleichbar. Die medianen Behandlungskosten für ein Kind mit NAS betrugen 13 457 € (IQR 8 967–17 494)/Patient [mit Rooming-in: 9 547 € (IQR 7 024–16 135), ohne Rooming-in: 14 486 € (IQR 9 479–19 352)].

Schlussfolgerung:

Rooming-in bei Kindern mit NAS ist möglich und kann die Therapiedauer, die Verweildauer im Krankenhaus und die Kosten verringern. Es entstanden keine größeren Probleme in der Versorgung der Kinder, wenn die Pflege hauptsächlich durch die Eltern erfolgte, allerdings ist eine engmaschige Überwachung der Kinder und die Anleitung der Eltern erforderlich.

Key words

newborn - withdrawal - neonatal abstinence ­syndrome - opiate - rooming-in - methadone

Schlüsselwörter

Neugeborenes - Entzug - Neonatales Abstinenz-­Syndrom - Opiate - Rooming-in - Methadon

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