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Outcome Differences in Neonates Exposed In-Utero to Opioids Managed in the NICU Versus Pediatric Floor

Lembeck, Amy L., DO; Tuttle, Deborah, MD; Locke, Robert, DO, MPH; Lawler, Laura, MD; Jimenez, Pamela, RN, MSN, FNP-BC/PNP-BC; Mackley, Amy, MSN, RNC; Paul, David A., MD

doi: 10.1097/ADM.0000000000000455
Original Research

Objective: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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).

Send correspondence to Amy L. Lembeck, DO, Einstein Medical Center Montgomery, East Norriton, Pennsylvania, PA. E-mail:

Received 12 January, 2018

Accepted 17 July, 2018

The authors report no conflicts of interest.

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© 2019 American Society of Addiction Medicine