1. Significance to Nursing
Effects of Breastfeeding on Neonatal Abstinence Syndrome (NAS) Kelli Benson, BSN
Hello, everyone. My name is Kelli Benson and this is my poster presentation to discuss the effects of breastfeeding on neonatal abstinence syndrome or NAS. I hope you enjoy it.
As a nurse, I have always worked with newborns both in the NICU and in newborn nurseries and postpartum units. One patient population that has only increased since I first became a nurse is infants who are born addicted to some type of drug, most often opioids, as a result of being exposed prenatally. NAS is a collection of central nervous, gastrointestinal, respiratory and autonomic symptoms that can affect infants exposed to opioids during pregnancy and can lead to the need for pharmacological treatment. The result of the pharmacological treatment is often an increased length of hospitalization for the infant. There has been some research into the relationship between breastfeeding of these infants and a decrease in the severity of NAS and this is what I was most interested in.
The PICOT question I developed to examine this problem is: How does breastfeeding compared to formula feeding affect the severity of Neonatal abstinence syndrome scores and length of hospital stay during the first month of life?
This PICOT question was used as a guide to search PubMed and CINAHL for articles using the terms neonatal abstinence syndrome and breastfeeding. Twenty-nine articles were found and six were utilized based on their publication which needed to be within the last 5 years, the needed to be written in English, and the studies needed to discuss feeding method in association with NAS and length of stay. Of the 6 studies reviewed, 2 were systematic reviews, 2 were cohort studies and 2 were descriptive studies.
All six studies showed a decrease in NAS in breastfed infants, although the results of one of the studies were not statistically significant. Severity of NAS was determined by length of stay, length of pharmacological treatment, and number of NAS scores recorded which were all decreased among breastfed infants when compared to formula fed or breast and formula fed infants. These studies primarily focused on opioid dependent women who were being maintained on methadone or buprenorphine which are both common opioid maintenance drugs.
All of this information leads me to conclude that breastfeeding can provide important benefits to neonates suffering from NAS such as a decreased length of pharmacological treatment and a decreased length of stay. These mothers need to be educated about these benefits and encouraged to breastfeed in order to improve outcomes for their newborns. The practitioners caring for these infants also need to be educated to support these mothers in their efforts to breastfeed because the overall goal is to improve patient outcomes.
These results are significant to nursing because nurses are the ideal candidates for providing education to mothers about breastfeeding and to change organizational policies to reflect evidence-based practice.
Methodology
PubMed & CINAHL searched guided by PICOT question
Critical analysis of 6 studies :
2 systematic reviews (Level I)
2 cohort studies (Level IV)
2 descriptive studies (Level VI)
Inclusion criteria:
Published in English in past 5 years
Discussed feeding method in association with NAS
Purpose
NAS affects infant exposed to opioids prenatally and can lead to:
Pharmacological treatment
Increased length of stay
PICOT: How does breastfeeding compared to formula feeding affect the severity of NAS scores and length of hospital stay during the first month of life? (
Results
6 studies reviewed
Focused on methadone or buprenorphine maintenance patients
All showed decreased NAS severity when breastfed compared to formula fed
Results of one study were not statistically significant
Severity determined by:
Length of pharmacological treatment
Number of NAS scores
Length of stay
Conclusion
Breastfeeding benefits:
Decreased number of NAS scores
Decreased length of stay
Decreased length of treatment
Mothers need to be educated about benefits
Practitioners need to be educated to support breastfeeding
Goal: improved patient outcomes ( (
Significance to Nursing
Nurses are at the bedside to educate and provide support to mother and infant
Nurses need to advocate to change policies to reflect evidence-based research
References:
Bagley, S. M., Wachman, E. M., Holland, E., & Brogly, S. B. (2014). Review of the assessment and management of neonatal abstinence syndrome. Addiction Science & Clinical Practice, 9(1), 19. doi: /
McQueen, K.A., Murphy-Oikonen, J., Gerlach, K., Montelpare, W. (2011). The impact of infant feeding method on neonatal abstinence scores of methadone-exposed infants. In K. McQueen, et al (Eds.) Advances in Neonatal Care, 11(4), doi:  /ANC.0b013e318225a30c
Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins
O’Connor, A. B., Collett, A., Alto, W. A., & O’Brien, L. M. (2013). Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy. Journal of Midwifery & Women’s Health, 58 (4), doi: /jmwh.12009
Pritham, U. (2013). Breastfeeding promotion for management of neonatal abstinence syndrome. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 42, doi: /
Pritham, U., Paul, J., & Hayes, M. (2012). Opioid dependency in pregnancy and length of stay for neonatal abstinence syndrome. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 41(2), doi: /j x
Wele-Strand, G. K., Skurtveit, S., Jansson, L. M., Bakstad, B., Bjarko, L, & Ravndal, E. (2013). Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatrica, 102, 1060–1066. doi: /apa.12378