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BACKGROUND: The prevalence of neonatal abstinence syndrome (NAS) is on the rise in the United States, as the epidemic of opioid misuse continues1. Several infants with in utero exposure to opioids are born with NAS, and exhibit symptoms of withdrawal and dependence upon birth when the maternal source of opioid is discontinued2. Due to the novelty of the syndrome, there are several knowledge gaps in current literature that remain to be explored. LITERATURE REVIEW: The exact mechanism of development of NAS in infants remains unknown, yet the clinical symptomatology and results of a few recent studies suggest that there is an association with NAS severity and dysregulation of autonomic nervous system (ANS) functioning in these infants3. In recent years, pharmacological treatments for these infants have become standardized4. However, non-pharmacological treatments have been adopted from treatment guidelines of other high-risk infant populations and their efficacy warrants further evaluation in infants with NAS. Kangaroo care (KC) is a supportive therapy commonly applied to many high-risk infant populations because of its physiologically stabilizing effects5. The therapy has been demonstrated to be especially beneficial in the treatment of preterm infants, a population that similarly requires additional maturation of their ANS upon birth,6. Neurobehavioral theories suggest ANS functioning in infancy is a strong predictor of long-term social, behavioral, and cognitive development outcomes7,8. PROPOSED PROJECT: This prospective cohort study is designed to provide pilot data to establish if KC can be utilized to mature ANS maturation in infants with NAS. CONCLUSIONS AND SIGNIFICANCE: KC is an inexpensive, readily available, low risk intervention that could improve neurobehavioral outcomes in infants with NAS. The results of this study could reduce clinical symptoms, potentiate long-term behavior outcomes, and better define treatment practices for infants with NAS by facilitating a targeted intervention to improve outcomes.

Neonatal abstinence syndrome (NAS) is a condition caused by in-utero exposure to opioids, and its occurrence is increasing nationwide. NAS patients are newborns who can experience withdrawal symptoms including tremors, poor feeding, and respiratory distress. Presently, the Finnegan Scoring System, a subjective rating scale, is commonly used to judge the patient's condition and determine appropriate treatment methods. This project sought to develop a sensor system that is capable of objectively assessing symptoms of withdrawal, including tremors and high pitched cry. The system developed is composed of five wireless accelerometers, for attachment to a subject's limbs and chest, and an external microphone. The sensor system is targeted toward quantifying limb movements of the subject and recording audio information that includes samples of the subject's cry. The sensor system was used as part of a research study, and data was collected from recruited participants. A total of 29 out of 30 desired participants were enrolled and studied as part of the data collection process. Gathered data was analyzed using MATLAB, with motion data being searched for tremor activity in NAS participants, and cry samples searched for unique characteristics. Results generated indicate that detection of tremors was successful, and that the average fundamental frequency of cry differs between the NAS and non-NAS participants. Future considerations for this project include expanding to measure more symptoms, and system refinement to minimize the number of sensors. / Master of Science / Neonatal abstinence syndrome (NAS) is a condition affecting newborns, caused by exposure to opioids before birth, and its occurrence is increasing nationwide. NAS patients are newborns who can experience withdrawal symptoms including tremors, poor feeding, and respiratory distress. Presently, the Finnegan Scoring System, a manual scoring method, is commonly used to judge the patient’s condition and determine appropriate treatment methods. This project sought to develop a sensor system that is capable of measuring symptoms of withdrawal, specifically tremors and high pitched cry. The system developed is composed of five wireless accelerometers, for attachment to a subject’s limbs and chest, and an external microphone. The sensor system is targeted toward quantifying limb movements of the subject and recording audio information that includes samples of the subject’s cry. The sensor system was used as part of a research study, and data was collected from recruited participants. A total of 29 out of 30 desired participants were enrolled and studied as part of the data collection process. Gathered data was analyzed using MATLAB, with motion data being searched for tremor activity in NAS participants, and cry samples searched for unique characteristics. Results generated indicate that detection of tremors was successful, and that the average cry for NAS participants was higher pitched than those of non-NAS participants. Future considerations for this project include expanding to measure more symptoms, and minimizing the number of sensors used. If successful, such a system could be used to assist medical personnel and continuously monitor NAS newborns.

Objective: The purpose of this study was to determine the characteristics, assessment, and treatment of infants with Neonatal Abstinence Syndrome (NAS) as perceived by Speech-Language Pathologists (SLP) and whether it differed from those of other Neonatal Intensive Care Unit populations. Methods: A secure web-based questionnaire with 62 questions collected information on NAS, caseloads, treatment environment, and demographics. Twenty-six respondents initiated the survey; 42% completed most or all questions. Response analyses included descriptive and nonparametric inferential statistics. Results: Infants with NAS were on the caseloads of 73% of respondents. The majority (79%) only saw infants with NAS and feeding problems. Primary problems included incomplete or increased time to complete feeds, increased/excessive/irregular sucking rates, and reflux. Working on teams, respondents provided assessment, treatment, and education of infant feeding and state. Conclusion: Growing demand for SLP intervention with infants with NAS is likely to persist if opioid use continues to increase as projected.

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