Graduation Year

2018

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Nursing

Major Professor

Denise Maguire, Ph.D.

Committee Member

Ming Ji, Ph.D.

Committee Member

Theresa Beckie, Ph.D.

Committee Member

Aaron Germain, MD

Keywords

Factor Analysis, Modified-FNAST, Neonatal Abstinence Syndrome, Opioid, Reliable, Valid

Abstract

There are currently no published scoring instruments with prior empirical evidence to support the validity and reliability of the accuracy of the drug withdrawal scores generated in infants greater than 28 days of life with a diagnosis of Neonatal Abstinence Syndrome (NAS). This study was done to identify the signs of withdrawal in infants greater than 28 days of life with NAS and determine if further adaptation of the modified-FNAST was necessary to accurately measure the severity of drug withdrawal in this sub population of infants. This aim could not analyzed due to limitations of the data.

The study was also done to describe the relationship between the medications used to treat the infant NAS and the longitudinal trajectory of the Finnegan scores. The results of the study revealed that the total modified-FNAST scores ranged from 0-21 on day 1 of life with a mean of 8.68 and a SD (4.127), and then gradually decreased with less variability over the length of the hospitalization until discharge. Four medications were used to treat the infants for NAS. The medications used to treat the infants for NAS included morphine (99%), phenobarbital (66.2%), clonidine (25.1%), and buprenorphine (1.9%). The minimum to maximum dosage and minimum to maximum duration of inpatient treatment days for each of the medications were explored and revealed, morphine (dosage range, 0.33-2.170 mg/kg/day and duration of 14-81 days), buprenorphine (dosage range 7.00-61.30 mcg/kg/day and duration of 4.00-30.00 days), clonidine (dosage range 3.97-28.93 mcg/kg/day and duration of 16.00-87.00 days), and phenobarbital (dosage range 3.00-16.00 mg/kg/day and duration of 2.00-84.00 days). Most of the infants received morphine alone or in combination with phenobarbital or clonidine consistent with the established evidence-based NAS weaning protocol. The Mixed Effects Model Analysis revealed that there was an overall decrease in the total Finnegan scores over time (p < 0.0001). The mean total Finnegan scores showed a statistically significant difference in the groups treated with and without clonidine (p = 0.0031). The group treated with clonidine had higher mean total Finnegan scores. The infants treated with phenobarbital did not show a significant association with the total Finnegan scores (p = 0.6852). In addition, all other control variables failed to show significant associations with the repeated measures of total Finnegan scores including: gender (p = 0.6257), infant birth weight (p = 0.9375), gestational age (p = 0.8444) and the estimated number of cigarettes smoked by the mother during the pregnancy (p = 0.7300). The interaction between the infants treated with clonidine and phenobarbital were not statistical significant either. (p = 0.6412).

Key Words: Neonatal Abstinence Syndrome, opioid, modified-FNAST, reliable, valid, factor analysis

Download

Included in

Nursing Commons

Share

COinS