Improving Hospital Care of Opioid-Exposed Newborns: Successes and Remaining Questions.

Abstract

Between 1999 and 2014, the rate of opioid use among US pregnant women at the time of delivery quadrupled. It is currently estimated that nationwide, 14% to 22% of women fill an opioid prescription during pregnancy. For newborns exposed to intrauterine opioids, the immediate risks include the postnatal withdrawal syndrome known as neonatal abstinence syndrome (NAS), which is currently estimated to affect one US birth every 15 minutes.1 Clinical monitoring for newborns with intrauterine opioid exposure, as well as treatment approaches for NAS, varies widely across US hospitals.2 Multidisciplinary collaboration and standardization of screening for intrauterine opioid exposure, observation for and pharmacologic and nonpharmacologic treatment of NAS, and discharge planning are important for optimal clinical outcomes and also may improve maternal experience.3 Hwang et al4 describe findings of a two-year initiative by a clinical, public health, and policy collaborative in Colorado state. The Colorado Hospital Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC) aimed to decrease the average length of stay (LOS) by 20% from baseline for all opioid-exposed newborns (OENs), decrease the proportion of OENs who receive opiate therapy by 20% from baseline, and decreased LOS for OENs requiring opiate treatment by 20% from April 2017 to December 2019. The collaborative’s interventions were focused on improving nonpharmacologic care, increasing use of human milk, increasing consistency in assessment for NAS by using the Eat, Sleep, Console …