PC1124: The Use of Weighted Blankets in Infants with Neonatal Opioid Withdrawal Syndrome

Background: Neonatal Opioid Withdrawal Syndrome (NOWS) occurs secondary to the abrupt discontinuation of fetal exposure to addictive substances after birth. Management often requires admission to the neonatal intensive care unit (NICU) for pharmacologic and non-pharmacologic treatments. Currently, Eat Sleep Console (ESC), a well-studied standard of care, supports the use of non-pharmacologic therapies. However, the parental unit is not always available to participate in ESC. With the booming opioid crisis, NOWS has led to a staggering rise in NICU admissions over the past decade. We hypothesized that including weighted blankets in NOWS treatment protocols would provide the tactile and sensory stimulation necessary to decrease pharmacologic treatment requirements and length of NICU stay.

Methods: This is a non-blinded, prospective cohort study that was conducted at a Level III NICU. Infants with gestational age > 35 weeks who met NOWS score criteria were included: 3 consecutive NOWS scores of >8 or NOWS scores of >6 with positive toxicology. Scoring was conducted per modified Finnegan scoring guidelines. Infants with any additional diagnosis, such as intrauterine growth restriction (IUGR) or hyperbilirubinemia were excluded. Control data was collected retrospectively from 2017-2021, and weighted blankets were implemented between 2019-2021. Informed consent was obtained from a parent or guardian of each participant. Primary outcome measures included days of pharmacologic treatment and length of NICU stay.

Results: A total of 114 patients were diagnosed with NOWS between 2017 and 2021. A total of 20 patients met inclusion criteria, consented, and were provided with weighted blankets for the duration of their NICU stay. A total of 22 patients met criteria and were included in the control group. The remaining patients with NOWS suffered from comorbidities, were < 35 weeks gestational age, or withdrawal signs were not present or severe enough to require treatment. Average days of pharmacologic treatment was 27.3 days in the control group and 18.5 days in the treatment group. Average length of NICU stay was 35.8 days in the control group and 24.2 days in the treatment group. This is a 32.4% decrease in length of treatment (p=0.13), and a 32.5% decrease in length of NICU stay (p=0.05).

Conclusion: Our data shows a statistical and clinically significant decrease in length of stay for infants with NOWS of 32.5%. The average annual estimated burden of NOWS hospitalizations has been estimated at 1.5 billion dollars, with each additional day of hospitalization in a NICU equating to approximately $3,000. We believe that as we recruit patients in the upcoming year, our decrease in treatment time will become statistically significant, increasing the power of our study. Therefore, the addition of weighted blankets, which are low-cost tools, add value to current NOWS treatment protocols by reducing pharmaceutical treatment requirements and length of NICU stay.