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Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review

AIM: The purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). BACKGROUND: NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid e...

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Autores principales: Murphy-Oikonen, Jodie, McQueen, Karen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567897/
https://www.ncbi.nlm.nih.gov/pubmed/29739484
http://dx.doi.org/10.1017/S1463423618000270
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author Murphy-Oikonen, Jodie
McQueen, Karen
author_facet Murphy-Oikonen, Jodie
McQueen, Karen
author_sort Murphy-Oikonen, Jodie
collection PubMed
description AIM: The purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). BACKGROUND: NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid exposure in utero. Infants requiring pharmacologic treatment to manage withdrawal, traditionally receive treatment as a hospital inpatient resulting in lengthy hospitalization periods. However, there is evidence to suggest that some healthcare institutions are continuing outpatient pharmacologic weaning for select infants in a home environment. As there is no standard of care to guide outpatient weaning, assessment of the safety and effectiveness of this approach is warranted. METHOD: A systematic review of outpatient weaning for infants with NAS was conducted using the electronic databases PubMed, Nursing and Allied Health, CINAHL, Evidence-Based Medicine, Web of Science, Medline, and PsychINFO. Studies were eligible for inclusion in the review if they fulfilled the following criteria: (1) reported original data on outcomes related to the effectiveness or safety of outpatient weaning for infants with NAS, (2) infants were discharged from hospital primarily receiving opioid pharmacologic treatment for NAS, (3) the method included quantitative designs that included an inpatient comparison group, and (4) articles were published in English in a peer-reviewed journal. FINDINGS: The search identified 154 studies, of which 18 provided information related to NAS and outpatient weaning. After reviewing the remaining full-text studies, six studies met all inclusion and exclusion criteria. All studies identified that outpatient weaning for select infants was associated with shorter hospitalization compared with infants weaned in-hospital only and may be potentially effective in reducing associated healthcare costs. However, duration of pharmacologic treatment was longer in the outpatient weaning groups in the majority of the studies. Furthermore, adverse events were rare and compliance to follow-up treatment was high among those who received outpatient weaning.
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spelling pubmed-65678972019-06-21 Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review Murphy-Oikonen, Jodie McQueen, Karen Prim Health Care Res Dev Special Issue AIM: The purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). BACKGROUND: NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid exposure in utero. Infants requiring pharmacologic treatment to manage withdrawal, traditionally receive treatment as a hospital inpatient resulting in lengthy hospitalization periods. However, there is evidence to suggest that some healthcare institutions are continuing outpatient pharmacologic weaning for select infants in a home environment. As there is no standard of care to guide outpatient weaning, assessment of the safety and effectiveness of this approach is warranted. METHOD: A systematic review of outpatient weaning for infants with NAS was conducted using the electronic databases PubMed, Nursing and Allied Health, CINAHL, Evidence-Based Medicine, Web of Science, Medline, and PsychINFO. Studies were eligible for inclusion in the review if they fulfilled the following criteria: (1) reported original data on outcomes related to the effectiveness or safety of outpatient weaning for infants with NAS, (2) infants were discharged from hospital primarily receiving opioid pharmacologic treatment for NAS, (3) the method included quantitative designs that included an inpatient comparison group, and (4) articles were published in English in a peer-reviewed journal. FINDINGS: The search identified 154 studies, of which 18 provided information related to NAS and outpatient weaning. After reviewing the remaining full-text studies, six studies met all inclusion and exclusion criteria. All studies identified that outpatient weaning for select infants was associated with shorter hospitalization compared with infants weaned in-hospital only and may be potentially effective in reducing associated healthcare costs. However, duration of pharmacologic treatment was longer in the outpatient weaning groups in the majority of the studies. Furthermore, adverse events were rare and compliance to follow-up treatment was high among those who received outpatient weaning. Cambridge University Press 2018-05-09 /pmc/articles/PMC6567897/ /pubmed/29739484 http://dx.doi.org/10.1017/S1463423618000270 Text en © Cambridge University Press 2018 http://creativecommons.org/licenses/by/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited
spellingShingle Special Issue
Murphy-Oikonen, Jodie
McQueen, Karen
Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
title Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
title_full Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
title_fullStr Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
title_full_unstemmed Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
title_short Outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
title_sort outpatient pharmacologic weaning for neonatal abstinence syndrome: a systematic review
topic Special Issue
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567897/
https://www.ncbi.nlm.nih.gov/pubmed/29739484
http://dx.doi.org/10.1017/S1463423618000270
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