There has been an increase in the number of neonates suffering from neonatal abstinence syndrome (NAS) due to rising opiate use among pregnant women. Implementing and improving clinical practice guidelines for treating NAS could help standardize care and improve outcomes for affected infants. A literature review found that utilizing non-pharmacological treatments, revising medication protocols, providing nursing education on NAS, and introducing standardized guidelines could reduce infant length of hospital stay, treatment costs, and severity of NAS withdrawal symptoms. Adopting improved, evidence-based clinical practice guidelines may help address the growing problem of NAS and optimize treatment for these infants.

1. Improving and Implementing Clinical Practice Guidelines for Infants
with Neonatal Abstinence Syndrome Improves Outcomes
By: Hope Royce
Introduction
During recent years, professionals in the nursing field have seen an increase
in the number of neonates that suffer from neonatal abstinence syndrome.
As opiate drug use has become more common among pregnant women, so
has the incidence of neonatal abstinence syndrome. Neonatal abstinence
syndrome (NAS) occurs when infants withdraw from addictive (most
commonly opioids) substances that they received in utero. The withdrawal
process and symptoms vary from mild to severe and can be extremely
uncomfortable for the neonate. There is a lack of standardized care for these
neonates. This presentation will delve into the literature and research on
clinical practice guidelines for managing and treating neonatal abstinence
syndrome (NAS), and discuss nursing implications based on evidence-based
practice and research to propose some improvement on the treatment of
NAS. This will include why implementing and improving clinical practice
guidelines for NAS is relevant to professional nursing practice, a review of
the literature, the implications for nursing interventions and practice, how
implementing and improving clinical practice guidelines relates to Quality
and Safety Education for Nurses (QSEN) competencies, and the overall
findings and conclusions.
Relevance
There has been an increase in the number of neonates who suffer from
neonatal abstinence syndrome (NAS) due to maternal opiate use during
pregnancy. This issue is highly relevant to nursing practice because within
recent years the incidence of NAS has been increasing quickly. It is has
been reported that between 54% and 94% of all babies exposed to opiates in
utero suffer from NAS (Lall, 2008). Since NAS is becoming a more serious
problem, today’s nurses need to be educated on the severity of this
condition. By understanding the severity of this issue, neonatal nurses can
become better educated on NAS; they can work to implement and improve
clinical guidelines for treating NAS based on the most current evidence-
based research and best-practice protocols, and thus improve neonatal
outcomes.
Methods
A large portion of this project was dedicated to researching neonatal
abstinence syndrome (NAS) and synthesizing the literature. CINAHL with
Full Text was utilized to find ten peer-reviewed journal articles, which were
not more than three years old, on the topic. A literature synthesis and review
was conducted on the journal articles and research that was found.
Literature Review & Results
The literature review that was conducted supported the thesis that improving
and implementing standardized clinical practice guidelines for NAS is
essential to improving the quality of nursing care provided to the newborns,
which in turn improves their outcomes. Reviewing the literature revealed
several main areas for improvement in the management of NAS.
• Utilizing non-pharmacological treatment options: Breastfeeding while
on methadone or buprenorphine has been proven to be safe and effective.
Skin-to-skin contact, swaddling, minimizing external stimuli, and using
specially trained baby cuddlers are other non-pharmacological treatment
methods that have been implemented, and significantly decrease length of
stay and overall costs.
• Reviewing & Revising Medication Therapy: Buprenorphine
management therapy (BMT) has been researched and found to be equally
as effective as methadone management therapy (MMT), and even results
in less intense NAS symptoms. Neonates on BMT also require
significantly less morphine to treat NAS. Research also supports the use of
standardized medication and weaning protocols as they would be
beneficial to include in clinical practice guidelines and improve quality of
care.
• Mandatory Nursing Education on NAS: Nurses need further education
on NAS and adequate training. Studies conducted on nursing education on
the use of the Finnegan scoring tool showed increased nurse knowledge
and improved quality of care provided.
• Implementing & Improving Standardized Clinical Practice
Guidelines: Literature and research suggests that implementing the use of
standardized protocols and treatments will improve clinical practice
guidelines for NAS management. Newly recommended protocols to
include in clinical practice guidelines are toxicology screening procedures
and standardized treatment and weaning protocols.
Implications for Nursing Practice & QSEN
QSEN competencies are essential
for today’s professional nurse, and
they should strive to integrate these
competencies into clinical practice.
Improving clinical guidelines for
NAS clearly identifies a current
problem in the nursing clinical
setting, and easily relates to three of
the QSEN competencies:
• Teamwork and collaboration
• Evidence-based practice
• Quality improvement.
Conclusions
Implications for Nursing Practice:
• Conduct research on NAS
• Implement/improve standardized
clinical practice guidelines to
provide best practice possibilities
and create better neonatal outcomes
• Promote non-pharmacological
interventions
• Advocate for the use of new,
evidence-based protocols and
treatments
• Continue education
• Neonatal abstinence syndrome is a growing problem that
needs more attention.
• Improving upon the areas listed above and implementing
all areas into one set of standardized clinical practice
guidelines would allow for more standardized care that
decreases length of stay, reduces cost, and improves
neonatal outcomes.
• “Optimal treatment of the NAS population is hampered
by the lack of evidence-based standardized guidelines
and protocols” (Lucas, 2012).
• Further research need to be conducted on NAS as well as
on the effects of standardized clinical practice guidelines
on neonatal outcomes.
NAS Withdrawal Symptoms
Central Nervous System (CNS)
Symptoms
Tremors, irritability , high-pitched cry,
abnormal sucking, poor feeding, seizures
Autonomic System Symptoms Sneezing, yawning, mottling
Gastrointestinal Symptoms Diarrhea, vomiting
Pulmonary Symptoms Increased apnea, respiratory distress
Contact Information: For any questions contact Hope Royce; hroyce@stu.norwich.edu
**See back of poster for complete list of references**