Comparison of Neonatal Abstinence Syndrome Manifestations in Preterm Versus Term Opioid-Exposed Infants.
Elizabeth Allocco, Marjorie Melker, Florencia Rojas-Miguez and 3 others
PMID 27611018WHAT IT FOUND
Preterm methadone-exposed infants were scored less often for many NAS signs but more often for reflex, breathing, and feeding items.
Need for medication and hospital stay did not differ from term infants.
Key findings
01Preterm infants differed significantly in scoring frequency for 14 of 19 Finnegan items.
02Need for pharmacologic treatment (98% term versus 91% preterm), adjunctive therapy, and length of stay did not differ significantly.
03Preterm infants were scored less frequently for sleep disturbance, tremors, restlessness, increased muscle tone, excoriations, sweating, fever, nasal stuffiness, sneezing, excessive sucking, and loose stools, and more frequently for hyperactive moro reflex, tachypnea, and poor feeding.
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How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was retrospective chart review, not real-time scoring with face-to-face nursing feedback. No standardized intra-rater reliability program was used during the study period. First-line NAS medication changed during the study period, so treatment was not uniform. Preterm buprenorphine-exposed infants were too few to analyze. Maternal psychiatric medication exposure was higher in the preterm group and changed several scoring differences after adjustment. Prematurity-related diagnoses such as respiratory disease, feeding immaturity, and temperature instability affected Finnegan item scoring.
The easy way to misread this
Do not conclude that the current Finnegan scale is equally accurate for preterm infants. Similar need for medication and length of stay did not mean the scale captured the same symptoms, because preterm infants were scored differently for many items and prematurity diagnoses can mimic or mask NAS.