Neonatal abstinence syndrome (NAS) is an increasing problem in the United States, including Iowa. Opioid prescription in Iowa has quadrupled since 1999, and the incidence of reported NAS has increased from 0.3 per 1000 live births in Iowa in 1999 to 3 per 1000 live births in 2017. Although NAS was initially used to describe infants solely withdrawing from opiates used by mothers during pregnancy, we now realize that babies can have signs and symptoms of withdrawal from many drugs, prescribed or illicit, that induce dependence during pregnancy. Tools to assess NAS such as the Finnegan or modified Finnegan score are complicated with inter-observer variability. In addition, infants with NAS historically have been managed at a higher level of neonatal care increasing parent-infant separation, pharmacological intervention and prolonging hospital stays and costs.
The mission of the Iowa Neonatal Quality Collaborative is to create a guideline which includes potentially better practices for management of infants with NAS. The goal of the guideline will be to simplify the evaluation process and potentiate use of non-pharmacologic methods for early care. Hospital teams will partner with parents to help decrease the incidence of separation of newborns from their families and to decrease transfers to a higher level of care.
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