Management of Newborns with Prenatal Opioid Exposure: One Institution's Journey

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.