Aims To describe the demographics and complications associated with hospitalisation of infants with NAS in a district general hospital.
Methods In this retrospective chart review, infants admitted with NAS from 2006 to 2014 were identified using the HIPE system. Patient records were reviewed for evidence of patient harm using the 28 item NHS Neonatal Trigger Tool (NNTT).
Results 33 infants were identified with NAS and records were available for 31.26 were transferred from Special Care Baby Unit (SCBU) to the paediatric ward. Mean age of admission to SCBU was 12.6 h (range 0.2–61 hrs). Mean gestational age was 39 weeks (32–42 weeks). Mean birth weight was 2.8 kgs (1.77 kg −3.76 kg). Mean length of stay was 37.5 days (SCBU 15 days mean, ward 21 days mean). 27 patients were treated with Oromorph. Mean dose was 0.5 mg/kg/24h (0.3–1.5 mg/kg/day). 20 infants were admitted to SCBU solely to manage suspected NAS. Admission was prompted for the remainder by co-morbidities including hypoglycaemia, intrauterine growth restriction, prematurity and respiratory distress. Significant triggers identified using NNTT: 5 infants experienced superficial skin damage, 2 were readmitted to hospital within 30 days (bronchiolitis and constipation), 1 transfer to a tertiary cardiac centre, 2 incidences of delayed discharge. 10 experienced nosocomial infections all contracted on the general ward. (4 rotavirus, 3 adenovirus, 2 cellulitis, 1 clinical URTI). One patient received an additional medication dose in error, 3 patients had significant hypoglycaemia (<2 mmol/L), 1 patient received naloxone. 1 patient had significant hypernatraemia (>150 mmol/L). Where adverse events were noted the level of harm was identified as nil or transient as per NNTT outcomes.
Conclusion No patient sustained significant harm during admission but the rate of nosocomial infection is noted to peak after transfer out of SCBU. This raises questions as where best to manage this cohort of patients during their prolonged hospital stay.
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