Related Experiment Videos
Management of Newborns with Prenatal Opioid Exposure: One Institution's Journey
Susan Minear1, Elisha M Wachman1
1Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
Insights
This study details a successful six-pronged approach to managing neonatal abstinence syndrome (NAS) in newborns exposed to opioids prenatally. Key changes significantly reduced medication use and hospital stays, improving infant and mother outcomes.
Area of Science:
- Neonatal care
- Pharmacology
- Public Health
Background:
- Rising prevalence of neonatal abstinence syndrome (NAS) presents a critical challenge.
- Prenatal opioid exposure impacts newborns, necessitating improved management strategies.
Purpose of the Study:
- To re-evaluate and enhance institutional policies for managing newborns with prenatal opioid exposure.
- To implement a comprehensive, multi-faceted approach to care for infants with NAS.
Main Methods:
- Implemented a six-pronged strategy: prioritizing nonpharmacologic care, adopting the Eat-Sleep-Console (ESC) observation method, enhancing prenatal education, establishing a cuddler program, promoting parental presence, and switching NAS medication from morphine to methadone.
- Fostered collaboration between obstetrics, outpatient pediatrics, and inpatient teams.
- Utilized a quality improvement framework for implementation and feedback.
Main Results:
- Reduced medication treatment for NAS from 87% to 40%.
- Decreased the need for adjuvant medication from 34% to 2%.
- Shortened the average length of hospital stay from 18 days to 10 days.
Conclusions:
- A multidisciplinary, quality improvement-driven approach, supported by leadership, can significantly improve outcomes for newborns with NAS.
- Enhanced prenatal care and nonpharmacologic interventions are crucial.
- Long-term support for mother-infant dyads post-discharge remains an area for continued development.
Abstract:
The prevalence of newborns with neonatal abstinence syndrome (NAS) is rising sharply. To respond to this crisis, our institution re-examined our policies and procedures regarding our approach to the management of newborns with prenatal opioid exposure. Our 6-pronged approach included: (1) a commitment to nonpharmacologic care as first-line treatment; (2) a simplified function-based approach to observation of the infant (Eat-Sleep-Console); (3) improved prenatal education to prepare parents for the newborn's postnatal course; (4) a cuddler program; (5) strategies to help parents remain at the bedside; and (6) change from morphine to methadone for infants who require medication for NAS. Our obstetrics collaborators and outpatient pediatric colleagues have partnered with us to prepare mothers for delivery by strengthening them in their recovery prenatally and helping them maintain their recovery after discharge. Among many improvements, our changes resulted in a decrease in medication treatment for NAS (from 87% to 40%), a decrease in the need for adjuvant medication (from 34% to 2%), and a decrease in length of hospital stay (from 18 days to 10 days). The 3 most significant factors that have contributed to our success have been: (1) a committed champion leader; (2) a strong collaborative multidisciplinary team; and (3) a quality improvement approach that facilitates implementation of ideas easily and provides timely feedback to guide further change. Although we have seen notable improvements with our new approach, emerging data from our outpatient colleagues indicate that much more is needed to help improve the long-term health of these dyads.