Happy summer, readers! Although it’s hard to celebrate the warmth and joy that summer breathes this year with all the doom and despair that 2020 has brought, I still invite you to practice wellbeing, whatever that may look like for you. During this quarantine, our team has continued to dive into the research surrounding weighted blankets to provide you with a concise and thorough summarization of the findings and how they apply to you.
Previously our articles have stemmed around the theme of mental health conditions and how weighted blankets and other deep pressure stimulation interventions can reduce psychological health-related symptoms. Over the next few months, we are pleased to review the medical literature and provide some insight into how weighted blankets may reduce other common conditions. To start this line of research, we will get a bit controversial with infant weighted blankets as a neonatal abstinence syndrome treatment option.
What are your thoughts on substance abuse? Substance abuse is an extremely controversial topic, and very rarely do I find an individual on the fence with their opinions about it. I will be upfront about this topic and say that I worked in a medication-assistance treatment clinic for about a year while earning my master’s degree. Like many, I came in with the assumption that “substance use is a choice.”
Quickly my mind was changed as I was immersed in the science behind substance abuse and worked one-on-one for countless hours with my patients who genuinely wanted to get better and beat their addictions. I could go on a diatribe on substance abuse disorder literature, but instead, I will link these videos of my former teacher, Dr. Vance Shaw; he taught me about substance abuse, specifically opioid use dependence.
Opinions on substance abuse aside, there are obvious consequences associated with using on one’s health and the health of those around them. More specifically, if a pregnant woman uses certain substances than she risks having a child born with Neonatal Abstinence Syndrome (NAS). In layman’s terms, this means the child was exposed to substances in utero, and when they are born, they withdraw. The stigma with NAS is that it is caused solely by illicit substances, and when someone hears NAS, they automatically think “drug-addicted mother,” but it’s much more complicated than that.
Yes, NAS is most commonly associated with opioids, but opioids are not a black and white substance. Opioids are prescribed by physicians regularly as an alleviator for acute pain and are also used in the form of methadone nad suboxone to treat opioid use disorders. Other drugs that can cause NAS include SSRIs (antidepressants), benzodiazepines (anxiety medication), and even nicotine (no explanation needed) (Bass, 2015). How many people in your life (that you’re related to or friends with) smoke cigarettes? Take antidepressants? Take Xanax or Valium? 75 – 90% of babies exposed to those substances will be born with NAS, but how is NAS diagnosed?
How is Neonatal Abstinence Syndrome Diagnosed?
Another controversial topic is the diagnosis of NAS because it is profoundly objective; if the nurse is aware of the mother using substances, some are more likely to rate the child’s symptoms as higher, thus giving them a NAS diagnosis. The problem with this comes when pharmaceutical treatments are used. If you have a baby diagnosed with NAS who is not withdrawing, then giving them morphine is problematic — thus hospitals are trying to move more towards non-pharmaceutical treatments as the first line of treatment, but more on that later. NAS is primarily diagnosed using the Finnegan scale, where nurses rate the baby on the symptoms observed on the scale. The Finnegan has many symptoms that could result from other conditions not drug-related, and thus misdiagnosis is common.
The Finnegan scale works like this: once a symptom of withdrawal is observed, or if the mother has a documented history of substance use, nurses will rate the infant’s symptom existence and severity; this is done every four hours until symptoms are no longer existent and the infant can leave the NICU and/or hospital. There are different thresholds used to determine when withdrawal treatment should be started, but typically once an infant scores 8 three times in a row, treatment begins (Hamdan, 2017). When the Finnegan scale is used, a urine toxicology screening is also done with the infant and mother.
Neonatal Abstinence Syndrome Treatment Options
There are a variety of treatment options, but the two main categories are medication and no medication, it seems simple enough, right? Medicines used to treat NAS typically include opioids, barbiturates, benzodiazepines, clonidine, and phenothiazine; about 60% – 80% of infants born with NAS will be administered medication as a treatment. Essentially, doctors are weaning the infants off the drug that is in their system to prevent severe side effects associated with withdrawal such as seizures. Now imagine for a second that an infant has rated highly on the Finnegan scale due to another condition unrelated to NAS and then is administered medication. Luckily this isn’t common; in fact, I couldn’t find any documented reports. Urine toxicology reports eliminate this possible mistreatment.
Non-Pharmaceutical treatment methods are preferential and are typically started when the Finnegan scale is determined to be necessary. Conventional non-pharmaceutical treatments that have been shown to decrease symptom duration and hospital stay include breastfeeding and skin to skin contact (Wu and Carre, 2018). Another treatment that could become more normalized is weighted blankets.
Neonatal Abstinence Syndrome Treatment: Infant Weighted Blanket
Very recently, Summe, Baker, and Eichel (2020) published a study on weighted blanket use as part of a care regimen for infants with NAS and has found promising preliminary data that support the feasibility and effectiveness of weighted blankets as a treatment option.
Sixteen infants who were diagnosed with NAS were recruited to participate.
The infants’ data –Finnegan score, heart rate, respiratory rate, and temperature –were collected 30 minutes before the infants’ typical feeding/sleeping time. After baseline data were collected, a weighted or unweighted blanket (depending on the condition) was placed on the infant for 30 minutes. Immediately after the 30 minutes, data were collected again. Data were collected again about 30 minutes after the blanket was removed. Each infant had 2 sessions with the weighted blanket and 2 sessions with the unweighted blanket in a 24-hour period. This schedule was repeated daily until the infant was discharged from the hospital.
The weighted blanket used within this study was 1-lb and was placed on the infant so that they could move around underneath the blanket. Infants were swaddled and placed face up lying down; then the blanket was draped over their body.
Safety, effectiveness, and feasibility of weighted blankets as a NAS symptom reduction tool were the primary goals of this study.
- Safety was measured using temperature, and visual observation; there were no significant differences found in temperature between weighted blanket use and non-weighted blanket use. The nursing staff did not need to remove the blanket at any point during the study due to safety concerns.
- Effectiveness was founded through the Finnegan score data and heart rate data. During this study, they found that the Finnegan scale rating significantly decreased quicker when weighted blankets were used in 30-minute increments and that there were no adverse side effects with the infants using weighted blankets. Also, infant heart rates significantly decreased, which is another measure to demonstrate NAS symptoms subsiding at a quicker rate. The respiratory rate did not change significantly. As stated previously, the Finnegan score is objective, so this data may have been skewed if the nurses were aware of which blankets were weighted and which were placebo.
- 94% of mothers who were presented with the ability to participate in this study accepted. Nursing staff found implementing the weighted blankets to be easy, thus providing evidence of the feasibility of this intervention.
Change in Heart Rate Data
Weighted blankets are becoming a more researched intervention, which will help provide them with the title of “evidence-based” interventions. Future research on NAS and weighted blankets should include a higher sample set, but this study did an excellent job of providing preliminary evidence of the effectiveness, safety, and feasibility of weighted blankets. If you have read through more blog articles, then these findings will make sense as NAS is a condition which heightens the sympathetic nervous system, and weighted blankets have been shown to reduce this activity in other studies. As more and more evidence comes out to support the notion of weighted blanket reducing sympathetic arousal, we will soon be able to generalize findings to all conditions which include a symptom of sympathetic arousal; therefore, in the future, we may see weighted blankets as a first-line treatment intervention for more and more conditions and diseases.
Bass, P. (2015). Neonatal abstinence syndrome: because symptoms may or may not be present at birth, early screening and pharmacologic treatment can stabilize an infant experiencing narcotic withdrawal. Contemporary Pediatrics, 32(1), 26 +. Retrieved from https://link.gale.com/apps/doc/A456573662/AONE?u=tel_main&sid=AONE&xid=93e9229b
Hamdan, A. (2017). What is the finnegan scale in the assessment of neonatal abstinence syndrome (NAS) retrieved from https://www.medscape.com/answers/978763-94858/what-is-the-finnegan-scale-in-the-assessment-of-neonatal-abstinence-syndrome-nas
Summe, V., Baker, R., & Eichel, M. Safety, feasibility, and effectiveness of weighted blankets in the care of infants with neonatal abstinence syndrome. Advances in Neonatal Care, 0(0), 1-8. doi:10.1097/ANC.0000000000000724
Wu, D., & Carre, C. (2018). The impact of breastfeeding on health outcomes for infants diagnosed with neonatal abstinence syndrome: A review. Cureus, 10(7), e3061. https://doi.org/10.7759/cureus.3061