Newborns With Neonatal Abstinence Syndrome May Benefit From Rooming-In vs NICU Care

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Newborns with neonatal abstinence syndrome are typically cared for in neonatal intensive care units.
Newborns with neonatal abstinence syndrome are typically cared for in neonatal intensive care units.

Rooming-in with the mother or other family members is associated with fewer treatments and reductions in length of stay (LOS) vs care in neonatal intensive care units (NICUs) in newborns with neonatal abstinence syndrome (NAS), according to a systematic review published in JAMA Pediatrics.

Investigators evaluated a total of 6 studies comparing rooming-in vs NICU care in newborns with NAS. Newborn treatment with pharmacotherapy comprised the primary outcome. In addition, the investigators assessed the associations between both approaches with LOS, costs, and treatment hazards (ie, in-hospital adverse events [AEs] and readmissions).

Overall, the included studies supported the benefit of rooming-in vs NICU care for minimizing the use of pharmacotherapy (risk ratio [RR] 0.37; 95% CI, 0.19-0.71; I2 = 85%) and reducing LOS (weighted mean difference [WMD] –10.41 days; 95% CI, –16.84- –3.98 days; I2 = 91%). A sensitivity analysis confirmed these findings and supported rooming-in for reducing pharmacotherapy (RR 0.32; 95% CI, 0.18-0.57; I2 = 13%).

A total of three studies demonstrated a cost-savings benefit with rooming-in vs NICU care, but a statistical analysis was not performed to determine significance. Rooming-in was also associated with increased breastfeeding rates compared with NICU care in the qualitative analysis. Finally, the investigators observed no significant association between rooming-in and increased rates of in-hospital AEs or hospital readmission.

There was potential publication bias in the systematic review and meta-analysis, which may limit the findings. In addition, this analysis was unable to consistently perform an analysis on the secondary outcomes, due to the variation in the included studies.

Based on these findings, the investigators “recommend that rooming-in be considered as a preferred management strategy for opioid-exposed newborns and for newborns with NAS.”

Reference

MacMillan KDL, Rendon CP, Verma K, et al. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review and meta-analysis [published online February 5, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.5195
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