An evidence-based approach to managing neonatal abstinence syndrome
Kusak, Kimberly Larsen.
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Neonates born to mothers addicted to opiates may develop neonatal abstinence syndrome (NAS). An infant exposed to opiates in-utero causes the neonate to withdraw from the substance after birth. Neonates with NAS are at risk for adverse outcomes including seizures and death along with many adverse symptoms related to neurological excitability and gastrointestinal dysfunction as described by the American Academy of Pediatrics (1998). As mentioned by Hunt et al. (2008), neonates exposed to opiates are at higher risk for prematurity, low birth weight and adverse neurodevelopment. These risk factors are directly related to increased death and adverse outcomes for this population. Variability exists regarding the treatment of NAS. The project intention is to propose an evidence-based practice recommendation for the treatment of neonates with NAS, thus providing consistency in care. A thorough literature search was done using several search engines including Medline, Pubmed, Cochran Library, CINAHL, National Guidelines Clearinghouse, Medline via First Search, and individual journal searches. The evidence was compiled and reviewed for strong research technique including type of randomization, inclusion and exclusion criteria, population representation, bias, confounding variables, and loss to follow-up. Protocol recommendations include evidence based recommendations for the care of NAS including medication treatment protocols. The protocol's focus is on increased positive patient outcomes and safety. Specifically, the goal is to avoid adverse outcomes such as seizures and death along with decreased duration of treatment, hospital stay, and nursing care. Overall, the practice recommendations raise multidisciplinary team awareness, increases care consistency, and provides a method for early intervention.