P0706 - An Innovative, Objective Tool for Assessing and Managing Narcotic Withdrawal in Newborn Infants

Background

Neonatal abstinence syndrome (NAS) continues to be a major medical problem in newborn infants. Assessments of symptoms of NAS using scoring systems such as Finnegan scores (FS) are characteristically subjective, biased, and time consuming. Infants with NAS are at an increased risk for poor weight gain and the most reliable signs of withdrawal are likely to be movement related. Therefore, movement-related pulse oximetry artifact (MPOA) can potentially be used as an objective, reliable and efficient tool to assess and manage NAS.

Objective

To evaluate quantitative estimates of MPOA and compare them with FS in the assessment and management of NAS.

Design / Methods

We performed a retrospective, observational study in 14 infants admitted to the Neonatal Intensive Care Unit (NICU) with NAS between June 2016 and December 2018. Cardiorespiratory data including pulse oximetry were continuously recorded during the hospitalization in all infants. Demographic data, daily FS, and daily weights were obtained from the electronic medical record. Percentage of daily MPOA was estimated using an automated algorithm that compared heart rate (HR) from the cardiac monitor with the pulse oximeter-derived pulse rate (PR). If the difference between the HR and the 1-sec lagged PR was greater than 1 standard deviation from the 1 hour smoothed HR, data were considered to be movement artifact. This methodology has previously been described in the literature.

Results

Demographic characteristics of the study population are included in Table 1. MPOA data was non-normally distributed; therefore, analyses were performed using the log-transformed data. Repeated measures analyses were performed comparing Finnegan scores and the daily percentage of artifact for each day of admission for each patient. This analysis demonstrated a significant positive correlation between the percentage of daily artifact and the daily Finnegan scores when the day of life was controlled for in the model (p = 0.007), (Figure 1). For each percent change in artifact, FS increased by 0.08 (0.079, 0.081). Gestational age, the use of pharmacotherapy, the infant’s urine toxicology at birth, and the maternal urine toxicology at delivery were not associated with FS.

Conclusions

MPOA obtained from distorted heart rate waveforms may be an objective measure for assessing and managing narcotic withdrawal in newborn infants.