9: Comparison of Neonatal Abstinence Syndrome Outcomes Before and After Implementation of Revised Management Guidelines
Bibliographic record
Abstract
The incidence of Neonatal Abstinence Syndrome (NAS) has been steadily increasing. Canadian Institute for Health Information (CIHI) reported that the number of NAS cases increased from 171 diagnoses in 2003–2004 to 654 in 2010–2011, and the number of hospital beds used, rose from 5.6 per day to 23.4. Symptoms of NAS are varied and range from irritability and poor feeding to development of seizures. In March 2012, the Provincial Council for Maternal and Child Health (PCMCH) provided revised clinical practice guidelines for the management of NAS in order to standardize its management across all units, with the most notable change resulting in a decrease in time intervals for both Finnegan scoring and morphine therapy. The current study aimed to evaluate the PCMCH guidelines on newborn outcomes such as treatment duration, length of stay, and total amount of morphine prescribed, when compared to the previous management guidelines. A retrospective cohort study was conducted, comparing medical records of mother-infant pairs exposed to methadone or other opioids antenatally two years prior to the implementation of the PCMCH guidelines (March 2010–March 2012) and two years after implementation (April 2012–March 2014). Of the 167 charts screened for inclusion, 90 mother-infant pairs met the criteria. Gestational age at delivery and birth weight was similar for newborns managed under the previous guidelines or the PCMCH guidelines. Compared to newborns managed under the previous guidelines, newborns under the PCMCH guidelines required treatment for shorter duration (31.7±16.0 days vs. 24.1±11.5 days, P=0.016), had a reduced length of hospital stay (39.8±15.9 days vs. 31.2±11.1 days, P=0.006), and demonstrated a trend towards decreased total amount of morphine (9.39±5.15 mg/kg vs. 7.10±4.85 mg/kg, P=0.054). To our knowledge, this is the first study to evaluate the impact of the PCMCH guidelines on newborn outcomes since its implementation in March 2012. The current study demonstrates that under the PCMCH guidelines, there is reduced treatment duration, reduced length of hospital stay, and a trend towards decreased total amount of morphine prescribed. Future research should look to replicate these findings in a larger sample size.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".