428 - Bowen Therapy for Nonpharmacologic Care of Patients with Neonatal Abstinence Syndrome

Publication Number: 428.4119

Ruxandra Faraon-Pogaceanu, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Weston, FL, United States; Jenelle Faini, West Virginia University Children's Hospital, Morgantown, WV, United States; Megan Martino, West Virginia University Children's Hospital, Morgantown, WV, United States; Lesley Cottrell, West Virginia University School of Medicine, Morgantown, WV, United States; Mark Cody. Smith, West Virginia University School of Medicine., Morgantown, WV, United States; Autumn Kiefer, West Virginia University School of Medicine, Morgantown, WV, United States

Background: The incidence of neonatal abstinence syndrome (NAS) has steadily increased during the past decade as more infants have been born to mothers with opioid use disorder (OUD). The recommended first-line treatments for NAS are nonpharmacologic interventions which create a low-stimulation environment. Which alternative therapies offer the most relief from NAS symptoms is unclear.
Bowen Therapy (BT) is a dynamic tissue therapy involving the fascia and the muscle system. Considering the variety of the sensory nerve fibers contained at the fascia level and given the severe irritability observed after normal stimuli in patients with NAS, we aim to evaluate the impact of Bowen Therapy on modified Finnegan Scores (FS) in patients with NAS.

Objective: The objective of this study was to investigate the hypothesis that by using Bowen Therapy in babies with NAS we can ameliorate their symptoms and achieve a reduction in the need for pharmacologic interventions.

Design/Methods: This trial was conducted in a Level 4 Neonatal Intensive Care Unit (NICU).
All the NICU providers underwent five days of intensive BT training. Convalescing NICU patients without NAS received BT to show feasibility, after parental consent. BT was then added to the standard of care (SOC) for NAS nonpharmacologic interventions in our NICU. Bedside nurses assigned modified Finnegan Scores (FS) to quantify NAS severity. Morphine was prescribed for severe symptoms unresponsive to nonpharmacologic measures. We compared FS before and after BT with FS before and after other physiotherapies in a historical cohort. Subcategories of FS were also analyzed.

Results: Thirteen patients with NAS underwent 90 BT interventions. Modified FS declined after BT from a mean of 9.34 (4.4) to 7.23 (3.5) (t = 9.232; p=.000), with improvements in crying, sleep, and breathing. The majority (77%) did not require scheduled morphine. Reduced FS were seen after BT regardless of NAS severity.

Conclusion(s): Bowen Therapy is a noninvasive physiotherapy which is feasible to be delivered as part of a non- pharmacologic care bundle for patients with NAS. Given the safety of the Bowen technique and positive outcomes in treating adult and pediatric populations, further research should be conducted examining the efficacy of this therapy for treating neonatal conditions. Our study shows that Bowen Therapy can acutely reduce NAS symptoms, which may reduce length of hospitalization for NAS and healthcare costs associated with treating NAS. Higher-quality RCTs should be performed to assess the efficacy of Bowen Therapy versus other types of physiotherapy or other interventions for NAS.

Demographics of the Intervention Population versus Historical Controls with Neonatal Abstinence Syndrome (NAS).


Effect of Nonpharmacologic Physiotherapy Interventions on Modified Finnegan Scores.


Individual Patient Response to Bowen Therapy Based on Pre/Post Modified Finnegan Scores and Patient’s Baseline Morphine Treatment
Mean modified Finnegan scores are shown on the y-axis for each patient, and individual patients are represented by points on the x-axis. Patients are grouped by their morphine treatment needs, with those in the red area not requiring any morphine treatment, those in the black area requiring single rescue dose treatments, and those in the blue area requiring scheduled morphine treatment for NAS. The change in mean modified Finnegan scores after Bowen therapy is represented by the difference between the mean baseline score (blue) and the mean post-Bowen therapy score (green).

Demographics of the Intervention Population versus Historical Controls with Neonatal Abstinence Syndrome (NAS).


Effect of Nonpharmacologic Physiotherapy Interventions on Modified Finnegan Scores.


Individual Patient Response to Bowen Therapy Based on Pre/Post Modified Finnegan Scores and Patient’s Baseline Morphine Treatment
Mean modified Finnegan scores are shown on the y-axis for each patient, and individual patients are represented by points on the x-axis. Patients are grouped by their morphine treatment needs, with those in the red area not requiring any morphine treatment, those in the black area requiring single rescue dose treatments, and those in the blue area requiring scheduled morphine treatment for NAS. The change in mean modified Finnegan scores after Bowen therapy is represented by the difference between the mean baseline score (blue) and the mean post-Bowen therapy score (green).