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A Feasibility Study to Assess OMT for NAS

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A59-A60. doi: Subito , type of study: retrospective study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

infants [143]
NAS [23]
neonatal abstinence syndrome [3]
OMT [2951]
osteopathic manipulative treatment [2973]
pediatrics [375]
retrospective study [213]

Abstract:

Statement of Significance: Neonatal abstinence syndrome (NAS) occurs when an infant withdraws from substances they were exposed to in utero. Non-pharmacologic interventions to support withdraw tolerance are a focus of current research as they decrease LOS and cost (1, 2, 3). Osteopathic manipulative therapy (OMT) has been theorized to support NAS infants by decreasing somatic dysfunction, balancing sympathetic and parasympathetic nervous drive, and improving feeding, however, no studies have yet been conducted. Research Methods: We designed a retrospective chart review of 54 NAS infants born at a single community based teaching hospital in central Maine. Data gathered included birth and pregnancy information, substance use history, eat-sleep-console scores and team huddle outcomes, pharmaceutical interventions, length of stay, and time required to complete chart review. We also gathered information on osteopathic consults including the reason for the consult, what day of life the consult occurred, and how many treatment areas were addressed. Chart review was completed by three reviewers after a chart review protocol was created. Data Analysis/Results: We found that all desired information was accessible in the charts, however, chart review was time consuming. Infants who required pharmaceutical intervention had the greatest LOS and their charts took the longest to review. Of note, all of the osteopathic consults were requested for issues related to feeding. Our study was too small to complete statistical analysis and because of the small size, our groups differed in several factors including gestational age at delivery and weight category at delivery. Conclusion: Although we did find that we were able to access all desired data, we discovered several limitations to consider if we were to progress to a larger study. First, data gathering was time consuming. We could consider gathering fewer data points in a larger study, revising our protocol, and offering more training to reviewers. Next, OMT consults were placed for infants who had difficulty with feeding which could be an indication of withdraw intolerance. This may indicate that a retrospective study could be difficult to interpret as infants who receive OMT may already be having difficulty tolerating withdraw compared to their peers. Lastly, our desired outcome, decreased LOS, is driven by utilization of pharmaceutical intervention and by protocol with all infants with NAS requiring a 5 day minimum. In order to show that OMT is effective at decreasing LOS, we would either have to demonstrate that OMT decreased the need for pharmaceutical intervention or the dosage of medication necessary. This would require a large study size in order to obtain adequate power as only 13% of infants at our facility required pharmaceutical treatment. As a larger retrospective study would be limited by an NAS assessment change at our facility in 2018, a multicenter collaboration would be necessary.


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