A New Scoring System for the Assessment of Neonatal Abstinence Syndrome.

OBJECTIVE: This study aimed to evaluate the concordance of a new scoring system for neonatal abstinence syndrome (NAS) and NAS scores to the traditional Modified Finnegan Neonatal Abstinence Scoring Tool (M-FNAST) score. The NAS score is based on the physiology of withdrawal, with equal emphasis on behavior, and neurological signs. STUDY DESIGN: The NAS scores for a control group of 202 healthy, term neonates were compared with those for 45 term neonates with NAS. The NAS and M-FNAST scores obtained simultaneously in 45 term neonates with NAS were compared using correlation, linear regression, and receiver operating characteristic curve analysis to determine the validity, reliability, and specificity of the NAS scores. RESULTS: The association between the NAS and M-FNAST scores was high (Spearman's correlation, 83%; linear regression, 83%), with an area under the curve of the NAS score of 1.00 (p < 0.01). A cut-off NAS score ≥4 identified NAS neonates with a sensitivity of 100% and specificity of 96%. The values of intraclass correlation, interrater agreement, and Cronbach's α were 0.63, 0.88, and 0.63, respectively. CONCLUSION: The new NAS scoring system is valid, reliable, physiologically based, and correlates closely with the M-FNAST score. The NAS scores may require further validation before its use in clinical practice.

Bacterial Content of Fortified and Unfortified Holder Pasteurized Donor Human Milk During Prolonged Refrigerated Storage.

OBJECTIVE: To assess the microbial growth in unfortified and fortified Holder pasteurized donor human milk (HPDHM) during 96 hours of refrigerated storage in a clinical setting. METHODS: Thirty-six unfortified samples and 77 fortified samples of HPDHM were prepared in a neonatal intensive care milk preparation room and stored in the NICU refrigerator at 4°C to simulate a real-life feeding environment. One milliliter aliquots were removed at 24-hour intervals and cultured in duplicate for bacterial growth on solid blood agar medium. Viable bacterial colonies were characterized using standard microbiological methods. RESULTS: 96.5% of milk samples manipulated in a vertical laminar flow hood were negative for bacterial growth. In the remainder 3.5% of the samples, the maximum growth was 1 colony forming unit/0.1 ml plated. Higher colony counts were observed when the laminar hood was not used. In all cases, the colonies represented common skin bacteria and demonstrated an inconsistent and unsustained growth. Fortifier status and storage time were not significantly associated with increased bacterial growth (P > 0.05). CONCLUSIONS: Unfortified and fortified HPDHM remain largely free of bacterial growth for up to 96 hours of refrigerated storage in NICU settings. Sample handling techniques are important for preventing microbial contamination.