ABSTRACT
OBJECTIVE: This study aimed to compare the short-term outcomes of infants from our level IIIC neonatal intensive care unit in 2 different periods. MATERIALS AND METHODS: In this cohort study, data from preterm infants (≤29 weeks and birth weight <1500 g) registered in the Vermont Oxford Network system were divided into 2 periods, the first period between January 1, 2005, and December 31, 2009, and the second between January 1, 2010, and December 31, 2019. RESULTS: There was no difference in the distribution of preterm infants according to their gestational age subgroups (P = .169). Although the survival rate increased significantly in the second period (48.1% vs. 64.3% (P < .001), there was no difference in terms of survival without morbidity (P = .480). The frequency of antenatal care (P < .001), antenatal maternal steroid use (P < .001), cesarean section (P = .025), and small for gestational age (P < .003) increased in the second period. Surfactant treatment in the delivery room (P < .003), neonatal intensive care unit (P < .001), and nasal continuous positive airway pressure use before intubation as a part of initial resuscitation (P < .001), nosocomial infections (P = .001), patent ductus arteriosus requiring medical treatment (P = .011), and necrotizing enterocolitis (P = .014) were significantly more common, but early neonatal sepsis (P = .002) and discharge home with only formula (P = .010) were less in the second period. CONCLUSION: Differences were noted in the prognosis and treatment choices of preterm infants in the same unit between 2 periods. The analysis of neonatal intensive care unit data, through rigorous methods, may provide opportunities for the development of quality improvement projects to improve the quality of health care in developing countries.
ABSTRACT
INTRODUCTION: Neonatal opioid withdrawal syndrome occurs after exposure during pregnancies of mothers with an opioid use disorder. If non-pharmacological treatment is insufficient, pharmacological options are preferred, but a common treatment guideline has not yet been determined. Sublingual buprenorphine tablet is more prominent in the treatment. Since oral alternatives are not available in many clinics, as in our unit, parenteral morphine is still the drug of the first choice. In this paper, we reported that two babies with neonatal opioid withdrawal syndrome were successfully treated with a buprenorphine/naloxone combination, which was not previously shown in the literature. CASES: We followed two babies whose mothers had an opioid use disorder during their pregnancies. The modified Finnegan scoring scale was used for the assessment of the babies. Both infants developed persistent seizures with resistant withdrawal signs. An effective parenteral route could not be provided due to hemodynamic instability. Thus, IV morphine could not be used. Due to the lack of oral treatment alternatives, first, we tried phenobarbital up to 40 mg/kg orally. Afterward, we used buprenorphine/naloxone combined tablet sublingually, which has not been used in children before. Detailed written consent was obtained from the parents for the emergency use of this drug in advance. Shortly after this treatment, the seizures and withdrawal signs were controlled. There were no adverse effects and babies were discharged fully recovered. CONCLUSION: Sublingual Buprenorphine 2 mg + Naloxone 0.5 mg (4:1) tablet could be used efficiently and without side effects to treat neonatal opioid withdrawal syndrome.
