A Preliminary Assessment of the Effects of Pharmacist-Driven Methadone Stewardship for the Treatment of Neonatal Abstinence Syndrome at a Tertiary Children's Hospital.

OBJECTIVE: Lack of a standardized opioid wean guideline for the treatment of neonatal abstinence syndrome (NAS) has the potential to increase the length of the wean and subsequently the length of stay for neonates in the neonatal intensive care unit (NICU). The purpose of this study was to assess the effect of a pharmacist-driven methadone stewardship program for NAS treatment. METHODS: The NAS stewardship program consisted of provider, pharmacist, and nursing education, a pharmacy surveillance system rule, and an updated clinical practice guideline. The pre- and post-intervention period were defined as patients admitted to the NICU from July 2019-October 2019 and August 2020-November 2020, respectively. The primary objective was to assess the effect of the stewardship program on the duration of opioid treatment in days. Secondary outcomes included number of dose titrations and length of hospital stay. RESULTS: A total of 21 patients were included in this study. Neonates treated following the adoption of the stewardship program (n = 8) experienced a 34% decreased median duration of treatment (29 days vs 19 days; p = 0.84). Secondary endpoints of median number of titrations and length of stay were decreased by 15% (1.5 titrations; p = 0.52) and 24% (8 days; p = 0.85), respectively, leading to an average cost savings of $60,020 per patient. CONCLUSIONS: Implementation of a standardized stewardship guideline for treatment of NAS resulted in a favorable decrease in all considered endpoints. Implications of the study further support the need for more evidence-based standardized guidelines for optimal treatment of patients with NAS.

Achieving Vancomycin Troughs Within Goal Range in Low Birth Weight Neonates.

OBJECTIVE: Vancomycin is commonly used in the neonatal population to treat Gram-positive bacterial infections. Despite frequent use, consensus on the ideal dosing regimen in low birth weight (LBW) neonates is lacking. The objective of this research is to determine how frequently vancomycin troughs within goal range (10-20 mg/L) are achieved with empiric dosing in critically ill neonates and infants weighing less than 2500 g. METHODS: This retrospective review evaluated LBW infants who were admitted to a level IV NICU from January 2015 to December 2016. Patients were included if they had a vancomycin trough sample collected at steady state (after at least 3 doses). Three trough cohorts (subtherapeutic: <10 mg/L, therapeutic: 10-20 mg/L, and supratherapeutic: >20 mg/L) were compared with 1-way ANOVA for continuous data and a chi-square analysis for categorical data. RESULTS: A total of 74 patients were included, with a mean birth weight (BW) of 819.7 ± 355.4 g and a mean gestational age (GA) of 26.4 ± 3.7 weeks. Only 27 patients (36.5%) had therapeutic vancomycin trough concentrations. Subtherapeutic troughs were recorded in 40 patients (54.1%), while supratherapeutic troughs were recorded in 7 patients (9.5%). Although there was no difference between the initial dose, initial frequency was significantly different between cohorts (p = 0.04). CONCLUSION: Empiric dosing regimens do not produce vancomycin troughs within the goal range in most LBW patients.