{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T10:58:29Z","timestamp":1793703509299,"version":"4.5.1"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,8,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>To compare pharmacologic treatment strategies for neonatal abstinence syndrome (NAS) with respect to total duration of opioid treatment and length of inpatient hospital stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We conducted a cohort analysis of late preterm and term neonates who received inpatient pharmacologic treatment of NAS at one of 20 hospitals throughout 6 Ohio regions from January 2012 through July 2013. Physicians managed NAS using 1 of 6 regionally based strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Among 547 pharmacologically treated infants, we documented 417 infants managed using an established NAS weaning protocol and 130 patients managed without protocol-driven weaning. Regardless of the treatment opioid chosen, when we accounted for hospital variation, infants receiving protocol-based weans experienced a significantly shorter duration of opioid treatment (17.7 vs 32.1 days, P &amp;lt; .0001) and shorter hospital stay (22.7 vs 32.1 days, P = .004). Among infants receiving protocol-based weaning, there was no difference in the duration of opioid treatment or length of stay when we compared those treated with morphine with those treated with methadone. Additionally, infants treated with phenobarbital were treated with the drug for a longer duration among those following a morphine-based compared with methadone-based weaning protocol. (P \u2264 .002).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Use of a stringent protocol to treat NAS, regardless of the initial opioid chosen, reduces the duration of opioid exposure and length of hospital stay. Because the major driver of cost is length of hospitalization, the implications for a reduction in cost of care for NAS management could be substantial.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2013-4036","type":"journal-article","created":{"date-parts":[[2014,7,29]],"date-time":"2014-07-29T04:00:34Z","timestamp":1406606434000},"page":"e527-e534","source":"Crossref","is-referenced-by-count":108,"title":["A Multicenter Cohort Study of Treatments and Hospital Outcomes in Neonatal Abstinence Syndrome"],"prefix":"10.1542","volume":"134","author":[{"given":"Eric S.","family":"Hall","sequence":"first","affiliation":[{"name":"Perinatal Institute, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Wexelblatt","sequence":"additional","affiliation":[{"name":"Perinatal Institute, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moira","family":"Crowley","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospitals Rainbow Babies and Children\u2019s Hospital and Case Western Reserve University, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Grow","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Akron Children\u2019s Hospital, Akron, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa R.","family":"Jasin","sequence":"additional","affiliation":[{"name":"Department of Nursing, Dayton Children\u2019s Hospital, Dayton, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Klebanoff","sequence":"additional","affiliation":[{"name":"The Research Institute, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"McClead","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Nationwide Children\u2019s Hospital, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jareen","family":"Meinzen-Derr","sequence":"additional","affiliation":[{"name":"Perinatal Institute, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio;"},{"name":"Department of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedagiri K.","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Neonatology, ProMedica Toledo Children\u2019s Hospital, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Neonatology, ProMedica Toledo Children\u2019s Hospital, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele C.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospitals Rainbow Babies and Children\u2019s Hospital and Case Western Reserve University, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2014,8,1]]},"reference":[{"issue":"3","key":"2021120903430727500_B1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2012-3931","article-title":"Prenatal substance abuse: short- and long-term effects on the exposed fetus.","volume":"131","author":"Behnke","year":"2013","journal-title":"Pediatrics"},{"issue":"18","key":"2021120903430727500_B2","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1001\/jama.2012.3951","article-title":"Neonatal abstinence syndrome and associated health care expenditures: United States, 2000\u20132009.","volume":"307","author":"Patrick","year":"2012","journal-title":"JAMA"},{"issue":"6","key":"2021120903430727500_B3","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1542\/peds.101.6.1079","article-title":"Neonatal drug withdrawal.","volume":"101","author":"American Academy of Pediatrics Committee on Drugs","year":"1998","journal-title":"Pediatrics"},{"issue":"1","key":"2021120903430727500_B4","first-page":"58","article-title":"Late presentation of drug withdrawal symptoms in newborns.","volume":"127","author":"Kandall","year":"1974","journal-title":"Am J Dis Child"},{"issue":"1","key":"2021120903430727500_B5","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0889-8545(05)70362-4","article-title":"Opioid dependence during pregnancy. 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