A Roadmap to Improved Quality Outcomes in Neonates Exposed to Illegally Manufactured Fentanyl
Year: 2025
Type: article
Abstract: Objective: Illegally manufactured fentanyl has driven the dramatic increase in neonatal opioid withdrawal syndrome (NOWS) for which, no effective treatment protocol exists. Affected infants display severe symptoms, have high health care utilization and costs. Our aim was to decrease the mean length of stay (LOS) by 20% over 19 months for infants with NOWS using novel approaches to transition to Eat, Sleep, Console (ESC) management. Study Design: A multidisciplinary team and quality improvement methodology were used to treat NOWS in two phases, each adapted to fentanyl’s complex pharmacology. Beginning May 2023, a hybrid Finnegan/ESC protocol was implemented to address hospital barriers for a year before initiating full ESC management. Data were collected on infants > 35 weeks gestational age admitted to a level III neonatal intensive care unit. Primary metrics included LOS and total days/doses of morphine. Rates of apnea and naloxone were utilized as balancing measures. The LOS was plotted on a statistical process control chart and the data was summarized with descriptive statistics.Results: Outcomes were analyzed for 217 infants. The smart aim was exceeded with a mean LOS percent reduction of 29% (hybrid) and 49% (ESC). On average, decreased morphine days (22.5, 11.2, 6.9, P < 0.001) and doses (162, 63, 14, P < 0.001) were also observed. No significant changes in apnea occurred nor was naloxone used. Conclusions: This QI project provides a successful model by which any hospital setting can adopt ESC principles to safely reduce LOS, postnatal morphine usage, and costs.
Authors: Cristiane G. Lin, Christine Wade, Becky Micetic, Pooja Rangan, Natalie Wade, Vrinda Arora
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,050
OpenAlex ID: W4415269592