{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:27:27Z","timestamp":1699403247848},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008510","name":"University of Maryland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008510","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>At least 60% of the neonates with opioid withdrawal syndrome (NOWS) require morphine to control withdrawal symptoms. Currently, the morphine dosing strategies are empiric, not optimal and associated with longer hospital stay. The aim of the study was to develop a quantitative, model\u2010based, real\u2010world data\u2010driven approach to morphine dosing to improve clinical outcomes, such as reducing time on treatment. Longitudinal morphine dose, clinical response (Modified Finnegan Score (MFS)), and baseline risk factors were collected using a retrospective cohort design from the electronic medical records of neonates with NOWS (<jats:italic>N\u00a0<\/jats:italic>=\u00a0177) admitted to the University of Maryland Medical Center. A dynamic linear mixed effects model was developed to describe the relationship between MFS and morphine dose adjusting for baseline risk factors using a split\u2010sample data approach (70% training: 30% test). The training model was evaluated in the test dataset using a simulation based approach. Maternal methadone and benzodiazepine use, and race were significant predictors of the MFS response. Positive autocorrelations of 0.56 and 0.12 were estimated between consecutive MFS responses. On an average, for a 1,000\u00a0\u03bcg increase in the morphine dose, the MFS decreased by 0.3\u00a0units. The model evaluation showed that observed and predicted median time on treatment were similar (13.0 vs. 13.8\u00a0days). A model\u2010based framework was developed to describe the MFS\u2013morphine dose relationship using real\u2010world data that could potentially be used to develop an adaptive, individualized morphine dosing strategy to improve clinical outcomes in infants with NOWS.<\/jats:p>","DOI":"10.1002\/cpt.2093","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T19:16:20Z","timestamp":1603998980000},"page":"243-252","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Model\u2010Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real\u2010World Data"],"prefix":"10.1111","volume":"109","author":[{"given":"Nadeesri","family":"Wijekoon","sequence":"first","affiliation":[{"name":"Department of Mathematics and Statistics University of Maryland, Baltimore County Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwatobi","family":"Aduroja","sequence":"additional","affiliation":[{"name":"Department of Pediatrics School of Medicine University of Maryland Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica M.","family":"Biggs","sequence":"additional","affiliation":[{"name":"University of Maryland Medical Center Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina","family":"El\u2010Metwally","sequence":"additional","affiliation":[{"name":"Department of Pediatrics School of Medicine University of Maryland Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathangi","family":"Gopalakrishnan","sequence":"additional","affiliation":[{"name":"Center for Translational Medicine School of Pharmacy University of Maryland Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"e_1_2_10_1_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1600879"},{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6731a1"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-3520"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-3801"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1500439"},{"key":"e_1_2_10_6_1","volume-title":"Current Therapy in Neonatal\u2010Perinatal Medicine","author":"Finnegan L.P.","year":"1990"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3212"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2015.08.013"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-3835"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.5044"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-4036"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2016.10.003"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2019.01.007"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0026\u20104946.17.04928\u20103"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.3951"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2017-0077"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOP.0000000000000589"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1416"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.1023"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12405"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1923"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1907"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372\u2010019\u20100440\u20108"},{"key":"e_1_2_10_24_1","unstructured":"Modified Finnegan neonatal abstinence score sheet<https:\/\/lkpz.nl\/docs\/lkpz_pdf_1310485469.pdf> (2007). 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