Medical Student Cooper Medical School of Rowan University Skillman, New Jersey, United States
Background: Iatrogenic withdrawal occurs when analgesic or sedative agents are abruptly decreased, leading to symptoms of withdrawal. This is a complex condition to navigate as management is highly dependent on clinical signs and a subjective description of symptoms by patients. In the neonatal intensive care unit (NICU), management is further complicated by only clinical signs being used. There are multiple tools that are currently being utilized to quantify clinical signs including the Finnegan scale and Withdrawal Assessment Tool 1 (WAT-1). The Finnegan scale is used when newborn patients are suspected of neonatal abstinence syndrome (NAS), the most common cause of iatrogenic withdrawal in neonates. WAT-1 is similar to the Finnegan scale except it uses a slightly different set of symptoms that are assessed at different intervals. Objective: Currently, there are no specific guidelines in place for the treatment of iatrogenic withdrawal in the NICU. As a result, multiple tools are being used to inform care making management of this condition subjective and therefore, inefficient. This study seeks to determine the most clinically effective method of assessing iatrogenic withdrawal in the NICU in order to streamline treatment. Design/Methods: This project involved scoring neonates experiencing iatrogenic withdrawal every 3 to 4 hours with the Finnegan scale and WAT-1 scoring systems. These scores were then compared to the clinical judgment of nurses with a standardized questionnaire to determine which scoring system is most helpful for weaning. This questionnaire included the following three questions: Is the patient over-sedated? Is the patient withdrawing? Would you recommend weaning? Demographic information was also collected to assess each scoring system, including gestational age, post-conceptual age, patient birth weight, prior opioid exposure, respiratory support status, and neurological problems. The IRB for this study has already been approved. The timeline for this project involves finishing data collection within the upcoming weeks and then beginning data analysis.
