Current Trends in Care for Infants Diagnosed with Neonatal Abstinence Syndrome in Canada: A Discussion Paper

Authors

  • Sarah Madeline Gallant Dalhousie University and IWK Health https://orcid.org/0000-0002-0932-2124
  • Mari Somerville Dalhousie University and IWK Health
  • Sydney Breneol Dalhousie University and IWK Health
  • Christine Cassidy Dalhousie University and IWK Health

DOI:

https://doi.org/10.15273/hpj.v3i4.11512

Keywords:

Eat, Sleep, Console (ESC), Finnegan Neonatal Abstinence Scoring Tool (FNAST), Neonatal abstinence syndrome (NAS), Perinatal nursing care

Abstract

Introduction: Neonatal abstinence syndrome (NAS) is a growing epidemic across the globe. Infants diagnosed often require resource-intensive nursing care and are at risk for future complex health conditions. A shift in approaches to care for this population has been identified as a priority health care need across Canada. Objectives: This discussion paper aims to highlight the current shift in care for the NAS population, focusing on the Finnegan Neonatal Abstinence Scoring Tool (FNAST) and the Eat, Sleep, Console (ESC) model of care. Methods: A comprehensive search strategy was developed to explore the current trend in care for infants diagnosed with NAS: the transition from the FNAST to the ESC model of care. Four scholarly databases (CINAHL, PubMed, Cochrane, and Google Scholar) were searched. Relevant articles were critically analyzed for their implications on infant and family health, family experience, health system outcomes, and nursing practice. Discussion: In our review of the literature, the FNAST was the most used tool when caring for infants diagnosed with NAS. Although this tool has guided care for infants for decades, it presents some limitations, including subjectivity, invasive and lengthy assessments, and lack of collaboration. Many facilities across Canada are shifting to the ESC model of care as an alternative model. It has potential to address challenges of the care guided by the FNAST, with the ESC model emphasizing non-pharmacological care, a focus on the birth-parent–infant dyad, and dedication to a function-based assessment. Conclusion: Further efforts are needed to support the real-world implementation of evidence-based models of care for this population.

Author Biographies

Sarah Madeline Gallant, Dalhousie University and IWK Health

School of Nursing, PhD in Nursing Student

Mari Somerville, Dalhousie University and IWK Health

PhD, MPH, RDCIHR Health System Impact Fellow (Postdoctoral Stream)IWK Health & Dalhousie UniversityHalifax, NS 

Sydney Breneol, Dalhousie University and IWK Health

PhD (c) in Nursing

Christine Cassidy, Dalhousie University and IWK Health

PhD RN

Assistant Professor, School of Nursing

Faculty of Health | Dalhousie University

Affiliate Scientist | IWK Health

References

Anbalagan, S., & Mendez, M. D. (2023, March 6). Neonatal abstinence syndrome. In StatPearls. StatPearls Publishing. Retrieved April 1, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK551498/

Asti, L., Magers, J. S., Keels, E., Wispe, J., & McClead, R. E., Jr. (2015). A quality improvement project to reduce length of stay for neonatal abstinence syndrome. Pediatrics, 135(6), e1494–e1500. https://doi.org/10.1542/peds.2014-1269

Bagley, S. M., Wachman, E. M., Holland, E., & Brogly, S. B. (2014). Review of the assessment and management of neonatal abstinence syndrome. Addiction Science & Clinical Practice, 9, Article 19. https://doi.org/10.1186/ 1940-0640-9-19

Blount, T., Painter, A., Freeman, E., Grossman, M., & Sutton, A. G. (2019). Reduction in length of stay and morphine use for NAS with the “Eat, Sleep, Console” method. Hospital Pediatrics, 9(8), 615–623. https://doi.org/10.1542/hpeds.2018-0238

British Columbia Centre on Substance Use, B.C. Ministry of Health, B.C. Ministry of Mental Health and Addictions, & Perinatal Services BC. (2018, June 1). Treatment of opioid use disorder during pregnancy—Guideline supplement. https://www.bccsu.ca/wp-content/uploads/2018/06/OUD-Pregnancy.pdf

Byrne, P. J., Foss, K., Clarke, D., Wismark, J., & Cardinal, K. (2018). Whole-family treatment of neonatal abstinence syndrome. Canadian Medical Association Journal, 190(15), E477–E478. https://doi.org/10.1503/cmaj.69170

Carlson, K., & Kieran, K. (2019). Narratives of neonatal abstinence syndrome. Archives of Psychiatric Nursing, 33(3), 275–283. https://doi.org/10.1016/j.apnu.2019.01.011

Centers for Disease Control and Prevention. (2023, March 21). Data and statistics about opioid use during pregnancy. Retrieved April 1, 2023, from https://www.cdc.gov/pregnancy/opioids/data.html

Chin Foo, C. A., Dansereau, L. M., Hawes, K., Oliveira, E. L., & Lester, B. M. (2021). Improving the assessment of neonatal abstinence syndrome (NAS). Children, 8(8), Article 685. https://doi.org/10.3390/children8080685

Clark, A. F. (2019). Effect of a neonatal abstinence syndrome training program on nurses’ confidence and ability to use the Finnegan Scoring Tool. Nursing for Women’s Health, 23(6), 485–493. https://doi.org/10.1016/j.nwh.2019.09.005

Curran, M., Holt, C., Arciero, M., Quinlan, J., Cox, D., & Craig, A. (2020). Proxy Finnegan component scores for Eat, Sleep, Console in a cohort of opioid-exposed neonates. Hospital Pediatrics, 10(12), 1053–1058. https://doi.org/10.1542 /hpeds.2020-0190

Dodds, D., Koch, K., Buitrago-Mogollon, T., & Horstmann, S. (2019). Successful implementation of the Eat Sleep Console model of care for infants with NAS in a community hospital. Hospital Pediatrics, 9(8), 632–638. https://doi.org/10.1542/hpeds.2019-0086

Drago, M. J., Shabanova, V., Hochreiter, D., Grossman, M., & Mercurio, M. (2022). Does maternal incarceration impact infants with neonatal abstinence syndrome? Maternal and Child Health Journal, 26(5), 1095–1103. https://doi.org/10.1007/s10995-021-03356-4

Filteau, J., Coo, H., & Dow, K. (2018). Trends in incidence of neonatal abstinence syndrome in Canada and associated healthcare resource utilization. Drug and Alcohol Dependence, 185, 313–321. https://doi.org/10.1016/j.drugalcdep.2017.12.019

Finnegan, L. P., Connaughton, J. F., Jr., Kron, R. E., & Emich, J. P. (1975). Neonatal abstinence syndrome: Assessment and management. Addictive Diseases, 2 (1–2), 141–158.

Gomez-Pomar, E., & Finnegan, L. P. (2018). The epidemic of neonatal abstinence syndrome, historical references of its origins, assessment, and management. Frontiers in Pediatrics, 6, Article 33. https://doi.org/10.3389/fped.2018.00033

Grisham, L. M., Stephen, M. M., Coykendall, M. R., Kane, M. F., Maurer, J. A., & Bader, M. Y. (2019). Eat, Sleep, Console approach: A family-centered model for the treatment of neonatal abstinence syndrome. Advances in Neonatal Care, 19(2), 138–144. https://doi.org/10.1097/ANC.0000000000000581

Grossman, M. R., Berkwitt, A. K., Osborn, R. R., Xu, Y., Esserman, D. A., Shapiro, E. D., & Bizzarro, M. J. (2017). An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics, 139(6), Article e20163360. https://doi.org/10.1542/peds.2016-3360

Grossman, M. R., Lipshaw, M. J., Osborn, R. R., & Berkwitt, A. K. (2018). A novel approach to assessing infants with neonatal abstinence syndrome. Hospital Pediatrics, 8(1), 1–6. https://doi.org/10.1542/hpeds.2017-0128

Grossman, M. R., Osborn, R. R., & Berkwitt, A. K. (2017). Neonatal abstinence syndrome: Time for a reappraisal. Hospital Pediatrics, 7(2), 115–116. https://doi.org/10.1542/hpeds.2016-0119

Hein, S., Clouser, B., Tamim, M. M., Lockett, D., Brauer, K., & Cooper, L. (2021). Eat, Sleep, Console and adjunctive buprenorphine improved outcomes in neonatal opioid withdrawal syndrome. Advances in Neonatal Care, 21(1), 41–48. https://doi.org/10.1097/ANC.0000000000000824

Hirai, A. H., Ko, J. Y., Owens, P. L., Stocks, C., & Patrick, S. W. (2021). Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017. JAMA, 325(2), 146–155. https://doi.org/10.1001/jama.2020.24991

Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-in to treat neonatal abstinence syndrome: Improved family-centered care at lower cost. Pediatrics, 137(6), Article e20152929. https://doi.org/ 10.1542/peds.2015-2929

Knopf, A. (2017). To treat NAS, use mother‐infant bond; Results include reduced use of morphine, length of stay, and costs. The Brown University Child and Adolescent Behavior Letter, 33(7), 1–7. https://doi.org/10.1002/cbl.30223

Kocherlakota, P. (2014). Neonatal abstinence syndrome. Pediatrics, 134(2), e547–e561. https://doi.org/10.1542/peds.2013-3524

Lacaze-Masmonteil, T., & O’Flaherty, P. (2018). Managing infants born to mothers who have used opioids during pregnancy. Paediatrics & Child Health, 23(3), 220–226. https://doi.org/10.1093/pch/pxx199

Lavoie-Tremblay, M., Chevrier, A., Emed, J., Clausen, C., Biron, A., Oliver, C., & Aube, T. (2019, November). Global shortage of nurses. McGill University, Ingram School of Nursing. https://www.mcgill.ca/ nursing/files/nursing/nurse_shortages.pdf

Miller, P. A., & Willier, T. (2021). Baby STRENGTH: Eat, Sleep, Console for infants with neonatal abstinence syndrome. Advances in Neonatal Care, 21(2), 99–106. https://doi.org/10.1097/ANC.0000000000000840

National Institute for Children’s Health Quality. (2019, January 16). A mother-centered approach to treating neonatal abstinence syndrome. https://www.nichq.org/insight/mother-centered-approach-treating-neonatal-abstinence-syndrome

Nayeri, F., Ebrahim, B., Shariat, M., Dalili, H., Kalani, M., Karbasian, N., & Sheikh, M. (2017). Treating neonatal abstinence syndrome from clinical perspectives. Iranian Journal of Pediatrics, 27(4), Article e6266. https://doi.org/10.5812/ijp.6266

Nota Bene Consulting Group, BC Women’s Hospital and Health Centre, & Provincial Health Services Authority. (2022, June). Implementing Eat, Sleep, Console. http://www.bcwomens.ca/Professional-Resources-site/Documents/ PHSA_implementing%20eat-sleep-console-vFIN.pdf

Pahl, A., Young, L., Buus-Frank, M. E., Marcellus, L., & Soll, R. (2020). Non‐pharmacological care for opioid withdrawal in newborns. Cochrane Database of Systematic Reviews, 2020(12), Article CD013217. https://doi.org/10.1002/14651858.CD013217.pub2

Parlaman, J., Deodhar, P., Sanders, V., Jerome, J., & McDaniel, C. (2019). Improving care for infants with neonatal abstinence syndrome: A multicenter, community hospital–based study. Hospital Pediatrics, 9(8), 608–614. https://doi.org/10.1542/hpeds.2019-0083

Patrick, S. W., Schumacher, R. E., Horbar, J. D., Buus-Frank, M. E., Edwards, E. M., Morrow, K. A., Ferrelli, K. R., Picarillo, A. P., Gupta, M., & Soll, R. F. (2016). Improving care for neonatal abstinence syndrome. Pediatrics, 137(5), Article e20153835. https://doi.org/10.1542/peds.2015-3835

Perinatal Services BC. (2020, November). Practice resource: Care of the newborn exposed to substances during pregnancy: Instructional manual. http://www.perinatalservicesbc.ca/Documents/Education/Practice%20Resource%20ESC_WEB%202020_11_20.pdf

Ponder, K. L., Egesdal, C., Kuller, J., & Joe, P. (2021). Project Console: A quality improvement initiative for neonatal abstinence syndrome in a children’s hospital level IV neonatal intensive care unit. BMJ Open Quality, 10(2), Article e001079. https://doi.org/10.1136/bmjoq-2020-001079

Rockefeller, K., Macken, L. C., & Craig, A. (2019). Trying to do what is best: A qualitative study of maternal–infant bonding and neonatal abstinence syndrome. Advances in Neonatal Care, 19(5), E3–E15. https://doi.org/10.1097 /ANC.0000000000000616

Schiff, D. M., & Grossman, M. R. (2019). Beyond the Finnegan scoring system: Novel assessment and diagnostic techniques for the opioid-exposed infant. Seminars in Fetal & Neonatal Medicine, 24(2), 115–120. https://doi.org/10.1016 /j.siny.2019.01.003

Singh, R., & Davis, J. M. (2021). Escaping the Finnegan – Is it time? Seminars in Fetal & Neonatal Medicine, 26(3), Article 101218. https://doi.org/10.1016 /j.siny.2021.101218

Timpson, W., Killoran, C., Maranda, L., Picarillo, A., & Bloch-Salisbury, E. (2018). A quality improvement initiative to increase scoring consistency and accuracy of the Finnegan Tool: Challenges in obtaining reliable assessments of drug withdrawal in neonatal abstinence syndrome. Advances in Neonatal Care, 18(1), 70–78. https://doi.org/10.1097 /ANC.0000000000000441

Verklan, M. T. (2019). Time for the Finnegan Neonatal Abstinence Syndrome Scoring Tool to be retired? The Journal of Perinatal & Neonatal Nursing, 33(3), 276–277. https://doi.org/10.1097/JPN.0000000000000427

Wachman, E. M., Grossman, M., Minear, S., & Whalen, B. (2017). Eating, Sleeping, Consoling (ESC) neonatal abstinence syndrome (NAS) care tool instructional manual (1st ed.). Boston Medical Center. https://www.cffutures.org/ files/QIC_Resources/Learning_with_the_Expert/Eat_Sleep_console_manual_with_tools_Yale_Boston_NNEPQIN.pdf

Wachman, E. M., Grossman, M., Schiff, D. M., Philipp, B. L., Minear, S., Hutton, E., Saia, K., Nikita, F., Khattab, A., Nolin, A., Alvarez, C., Barry, K., Combs, G., Stickney, D., Driscoll, J., Humphreys, R., Burke, J., Farrell, C., Shrestha, H., & Whalen, B. L. (2018). Quality improvement initiative to improve inpatient outcomes for Neonatal Abstinence Syndrome. Journal of Perinatology, 38(8), 1114–1122. https://doi.org/10.1038/s41372-018-0109-8

Whalen, B. L., Holmes, A. V., & Blythe, S. (2019). Models of care for neonatal abstinence syndrome: What works? Seminars in Fetal & Neonatal Medicine, 24(2), 121–132. https://doi.org/10.1016 /j.siny.2019.01.004

Winkelman, T. N. A., Villapiano, N., Kozhimannil, K. B., Davis, M. M., & Patrick, S. W. (2018). Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004–2014. Pediatrics, 141(4), Article e20173520. https://doi.org/10.1542/peds.2017-3520

Zimmermann-Baer, U., Nötzli, U., Rentsch, K., & Bucher, H. U. (2010). Finnegan neonatal abstinence scoring system: Normal values for first 3 days and weeks 5–6 in non-addicted infants. Addiction, 105(3), 524–528. https://doi.org/10.1111 /j.1360-0443.2009.02802.x

Published

2023-11-29

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