Neonatal abstinence syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting.

OBJECTIVE: Each year in the US ∼50 000 neonates receive inpatient pharmacotherapy for the treatment of neonatal abstinence syndrome (NAS). The objective of this study is to compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program. STUDY DESIGN: Retrospective review (2007 to 2009). Infants were born to mothers maintained on methadone in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 patients) was inpatient, whereas the combined group (46 patients) was outpatient. RESULT: Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, gestational age (GA) and the incidence of prematurity (34 and 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25 days; P<0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21 days, P<0.01), the cumulative methadone dose was similar (3.6 vs 3.1 mg kg(-1), P=0.42). Follow-up information (at least 3 months) was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen ≤72 h from hospital discharge. Breastfeeding was more common among infants in the combined group (24 vs 8% P<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (34 to 36 weeks GA) was the only predictor for hospital readmission for NAS in both groups (P=0.02, OR 5). Average hospital cost for each infant in the combined group was $13 817 less than in the traditional group. CONCLUSION: A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost. Additional studies are needed to evaluate the potential long-term benefits of the combined approach on infants and their families.

Proposed method of well-child care in a resident's clinic.

Uniformity in a teaching hospital's pediatric outpatient clinic is often inconsistent because of the varying numbers of housestaff involved in patient evaluation. We have developed a flow sheet that defines the appropriate standards of care to be delivered at the Doctors Hospital Pediatric Outpatient Clinic. This flow sheet encompasses a method of rapid assessment of growth, development, physical examination, immunization status, screening laboratory testing, and parental education. We have defined these parameters as the minimal evaluation to be completed at each preschool well-child visit.

Very low-birth weight infant. I. Influence of place of birth on survival.

In order to assess the influence of place of birth on the survival of the very low-birth weight (VLBW) infant, premature deliveries that occurred at hospitals located in an urban county were studied. All premature infants born alive during the years 1977 through 1979 whose birth weights ranged from 500 to 1,250 gm were included. The outcome for the VLBW infants born at the Ohio State University Regional Perinatal Center (OSU-RPC) was compared to that for VLBW infants delivered at the other five community hospitals with maternity services. Thirty-eight percent of the 270 VLBW neonates born at the community hospitals and 53% of the 186 VLBW premature infants delivered at the OSU-RPC survived. These differences are statistically significant at the p less than 0.01 level. Delivery at a perinatal center where comprehensive maternal-fetal-neonatal services are available improves survival for the VLBW infant.

Spontaneous corneal perforation with expulsion of the lens and retina in a premature infant.

This case presents an additional ophthalmological complication in the infant under 1000 gm. The potential relationship of spontaneous corneal perforation suggests the need for extreme care in eye management in these infants.