127 Neonatal Abstinence Syndrome: Variation and Barriers in Care in Canada
Bibliographic record
Abstract
Neonatal abstinence syndrome (NAS) is the withdrawal in newborns that presents following prenatal exposure to drugs such as opioids, benzodiazepines and SSRIs. NAS is a complex, multi-system disorder that can vary in severity. Signs range from mild tremors and irritability to the extremes of fever, seizures and excessive weight loss. With increasing diagnosis rates, the Canadian Paediatric Society (CPS) issued a practice point in 2018 to standardize management. In parallel, we carried out a survey to learn more about the state of NAS management in Canada. The survey was created with two major objectives: 1) to determine the variation in practice across Canada and 2) to gauge knowledge/perceptions around NAS care. A cross-sectional survey was conducted through the Canadian Paediatric Surveillance Program (CPSP), a network that represents over 2,700 Canadian paediatricians and paediatric subspecialists in active practice. The survey instrument was developed and distributed in early August 2018 to 2808 physicians. Respondents were given approximately 1.5 months to complete the survey and two survey reminders were issued during this timeframe. Following receipt of surveys, data were forwarded to the investigators for statistical analysis to identify variations and barriers in care across Canada. Funding for this survey was provided by the CPSP and there are no conflicts of interest to report. Questionnaires were received from 878 respondents, with a total response rate of 31.3%. Of those, 59.4% of respondents indicated that they provided care for infants with NAS. 64.2% of respondents reported that their practice settings had established neonatal care guidelines for NAS, with only 28.9% of them using the CPS practice point for management. For assessment of severity, 90.4% of respondents used either the Finnegan score (51.4%) or the modified Finnegan score (39.0%). As the first location of care for stable infants with NAS, 45.9% of respondents indicated that their practice settings are employing rooming-in with the mother, while 30.1% still utilize the NICU and 21.6% use special care nurseries. The largest barriers to the adoption of rooming-in care are staff concern over monitoring and evaluation, insufficient nursing resources, as well as the need for education and training. This survey documents the extent of variation in NAS management procedures across the country and potential barriers to practice point adoption. These findings will further inform educational outreach and be used to improve future NAS care in Canada.
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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 | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.007 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".