Computer-based modeling is able to reduce the length of hospital stay and duration of treatment for newborns born with neonatal abstinence syndrome (NAS), or opioid drug addiction and withdrawal.
Researchers at Cincinnati Children’s Hospital Medical Center used computer models to represent pharmacokinetics (the movement of a drug from the moment it is administered up to the point at which it is completely eliminated from the body). This reduced the duration of methadone treatment from 16.4 to 14.1 days and inpatient treatment from 21.7 to 18.3 days for infants with NAS.
Recent statistics have shown an increase in the admission of newborns with NAS to intensive care units from seven cases per 1,000 admissions to 27 per 1,000 admissions from 2004 through 2013. These infants are born in drug withdrawal — often in critical condition — having been exposed in utero to a range of opiates and opioids, from Percocet and Vicodin to heroin.
It is essential that NAS is detected before the newborn goes home. The problem, however, is that symptoms may not occur for 48 hours, and many babies go home with their mothers after delivery with no one there to treat their withdrawal. They may end up failing to thrive, or in emergency departments with seizures.
“The incidence of neonatal abstinence syndrome after an infant’s in utero exposure to opioids has risen dramatically in recent years,” says Eric Hall, Ph.D., a researcher in the Perinatal Institute at Cincinnati Children’s and lead author of the study.
“Future protocol refinements may include personalized treatments, including strategies based on bedside pharmacogenetic analyses or individual opioid exposure profiles, which take into account individual genetic responses to drugs.”
The study was conducted at six newborn nurseries in southwest Ohio and was based on a standardized protocol previously developed by the Ohio Children’s Hospital Neonatal Research Consortium. The findings showed an improvement in length of stay and duration of treatment.
In 2013, hospitals in the Cincinnati area became the first to begin widespread universal drug testing of all expectant mothers. Ohio law does not require notification of law enforcement if a maternal test is positive, unless there is suspicion of criminal behavior linked directly to the safety or well-being of the newborn. This diffuses a mother’s fear of criminal charges and increases the likelihood that she will agree to a urine sample.
“Prior to this program, one of four women using opioids went undetected. Today we are detecting nearly all,” says Scott Wexelblatt, M.D., a pediatrician at Cincinnati Children’s who has spearheaded the universal drug testing method.
The findings are published online in the Journal of Pediatrics.