249 - Assessment of Iatrogenic Withdrawal in the NICU

Publication Number: 249.3845

Rishi Yerram, Cooper Medical School of Rowan University, Skillman, NJ, United States; Danielle McDonald, Cooper University Health Care, Philadelphia, PA, United States; Krystal Hunter, Cooper Medical School of Rowan University, Camden, NJ, United States; Alla Kushnir, The Children's Regional Hospital at Cooper, Camden, NJ, United States

Background: Iatrogenic withdrawal occurs when analgesic or sedative agents given for medical reasons are abruptly decreased, leading to symptoms of withdrawal. This is a complex condition since management is highly dependent on clinical signs and subjective description by patients or caregivers.1 There are multiple tools that are currently being utilized, including the Finnegan scale and Withdrawal Assessment Tool 1 (WAT-1). The Finnegan scale is used to monitor Neonatal Opioid Withdrawal Syndrome (NOWS), a common cause of neonatal withdrawal from in-utero opioid exposure, but not intended to be for iatrogenic causes2. WAT-1 is a measure of iatrogenic opioid withdrawal but is validated to use in pediatric population rather than neonatal one1. Neither is meant for neonates undergoing withdrawal from iatrogenic opioid withdrawal.

Objective: To determine the most clinically effective method of assessing iatrogenic withdrawal in the NICU in order to streamline treatment and create a management protocol.

Design/Methods: This project was carried out by recording scoring of neonates experiencing iatrogenic withdrawal every 3 to 4 hours with the Finnegan scale and WAT-1 scoring systems, as well as using a standardized nursing questionnaire which included three questions: Is the patient over-sedated? Is the patient withdrawing? Would you recommend weaning? The scores of the 3 scales were then compared.

Results: Averaged Finnegan scale and WAT-1 scores were correlated with nurse questionnaire responses for each of the 3 questions using a Spearman Rho correlation coefficient. Scores for 14 patients over the whole duration of opioid weans were recorded and, the correlation coefficients between average Finnegan and each nursing question were r=-0.31, 0.42, and 0.36 (Table 1), and between average WAT-1 and each nursing coefficient were r=-0.38, 0.41, 0.31 (Table 2). There was significant correlation between mean Finnegan scores and WAT-1 scores (r=0.75, p=0.003) (Table 3).

Conclusion(s): There was no correlation between either scoring system and the nursing questionnaire. However, there was a significant correlation between the Finnegan and WAT-1 scoring systems. This implies that it is possible to use Finnegan scoring system for iatrogenic withdrawal in neonates who are past the initial 2-4 weeks of life and that the WAT scoring system may be used in early neonates and not just in the pediatric population. It also confirms that subjective assessment is not a reliable measure compared to standardized scoring systems.

Table 1: Spearman Rho Correlation between Average Finnegan Scores and Questions of Nursing Questionnaire (Clinical Judgement)


Table 2: Spearman Rho Correlation between Average Withdrawal Assessment Tool 1 (WAT-1) Scores and Questions of Nursing Questionnaire (Clinical Judgement)


Table 3: Spearman Rho Correlation between Average Finnegan Scores and Average Withdrawal Assessment Tool 1 (WAT-1) Scores