by Anne Eglash MD, IBCLC, FABM
Infants who are chronically exposed to opiates during pregnancy are at risk for undergoing opiate withdrawal after birth, termed Neonatal Abstinence Syndrome (NAS). These infants demonstrate jitteriness, irritability, sleep problems, seizures, and poor feeding, among other symptoms. Treatment of these symptoms requires longer stays in the hospital, causing maternal-infant separation, and increased costs of medical care. The typical treatment for NAS is either methadone or morphine, with a tapered dose over time. Evidence is mounting that breastfeeding may play an important role in the treatment of NAS, because of the transmission of opiates in breastmilk, assuming that the mother continues on opiates postpartum.
A large 2016 study identified 3,725 newborns in Pennsylvania with a diagnosis of NAS prior to discharge, with 44.5 % breastfeeding at discharge.
What do you think the authors found regarding the effect of breastfeeding on length of hospital stay for newborns with NAS? (choose 1 or more)
- There was no difference in length of hospital stay between infants who were breastfeeding or formula feeding.
- The breastfeeding infants had a hospital stay that was almost 10% shorter than the formula fed infants.
- The breastfeeding infants had a hospital stay that was longer by 15% because of the continued exposure of opiates through breastmilk.
- The breastfeeding infants were less likely to go to the neonatal intensive care unit.
See the Answer
Answer- B
The Association Between Breastfeeding and Length of Hospital Stay Among Infants Diagnosed with Neonatal Abstinence Syndrome: A Population-Based Study of In-Hospital Births
Short VL, Gannon M, Abatemarco DJ
OBJECTIVE:
The incidence of neonatal abstinence syndrome (NAS), a drug withdraw syndrome mainly associated with intrauterine opioid exposure, has increased considerably in the United States since 2000. Nonpharmacological options, including breastfeeding, may be effective at improving outcomes in this population. The objective of this population-based study was to examine the association between breastfeeding and length of hospital stay among infants diagnosed with NAS.
METHODS:
This was a retrospective cohort study of singleton in-hospital births to resident mothers in Pennsylvania. Hospital discharge data from births occurring between 2012 through 2014 were linked with corresponding birth certificate data. International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis codes were used to identify NAS neonates (N = 3,725). Breastfeeding at discharge was used to determine breastfeeding status. Infant and maternal characteristics were compared by breastfeeding status and the association between breastfeeding and infant length of hospitalization was assessed.
RESULTS:
Less than one-half of infants diagnosed with NAS were breastfed at discharge. Significant differences in infant birth weight and gestational age, and maternal education, marital status, prenatal care, smoking, and insurance status were found by breastfeeding status. A significant inverse relationship existed between breastfeeding and hospital length of stay for infants diagnosed with NAS. Specifically, length of hospitalization was reduced by 9.4% in the breastfed group compared to the nonbreastfed group.
CONCLUSION:
Breastfeeding may be beneficial for infants diagnosed with NAS by shortening the length of hospital stay. Future prospective studies are warranted to further examine the benefits of breastfeeding and other nonpharmaceutical interventions in NAS populations.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This is not the first study to demonstrate that breastfeeding reduces hospital stay for the treatment of NAS. This study just happened to be larger than previous smaller studies, which have shown similar outcomes.
We now have enough evidence to counsel pregnant mothers using opiates that breastfeeding can reduce the duration of treatment of NAS for their newborns. Although it is assumed that the opiates in breastmilk decrease NAS symptoms, the authors point out that the act of breastfeeding, which includes increased physical contact with mom, may also play a role in reducing the duration of NAS treatment.
Providers ought to work in concert with drug treatment centers to provide prenatal counseling and support of breastfeeding.