Newborn Opioid Withdrawal Requires a Cascade of Care, Study Suggests

Effective management of neonatal abstinence syndrome (NAS) requires a coordinated “cascade of care” from prevention through long-term follow-up, according to a study published in Advances in Neonatal Care.

Based on interviews with frontline providers caring for infants affected by NAS, researchers identified 4 essential areas to improve care for this increasingly common complication of opioid use.

“Greater resources, coordination, and cross-disciplinary education are urgently needed across the cascade of care to effectively address NAS,” wrote Jennifer L. Syvertsen, PhD, University of California, Riverside, California.

The researchers conducted in-depth interviews with 18 central Ohio healthcare providers caring for infants and families affected by NAS. Ohio has among the highest rates of opioid use and NAS in the United States. In 2015, nearly 2,200 infants were hospitalised for NAS.

“Rather than an acute diagnosis, we propose that NAS is better conceptualised as cascade of care, and there is a need to better coordinate and provide care at each stage of the cascade,” the authors wrote.

Informed by analysis of the provider interviews, the researchers discuss 4 interrelated components of the cascade of care:

• Prevention — Care begins with preventing the misuse of opioids and other drugs. Preventive efforts should encompass the social determinants of health, such as poverty, lack of education, and limited opportunities.

• Prenatal Care and Drug Treatment – The providers stressed the need for supportive care for pregnant women using opioids, rather than punitive approaches. While comprehensive care programs have yielded promising results, NAS can occur even in infants born to mothers receiving recommended medication-assisted treatment for opioid use disorder.

• Labor and Delivery — Infants must be monitored for signs of NAS, with treatment if needed; providers stressed that consistency in following protocols is critical to reducing infant length of stay in the hospital. Programs to sensitise staff and mitigate stereotyping attitudes toward the mothers of babies with NAS have led to better care. In rural areas, the infant has to be transported to a higher-level newborn intensive care unit, creating barriers to mother-infant bonding.

• Aftercare — Supportive aftercare includes access to drug treatment and social services, monitoring the child’s development, and providing a healthy home environment for the infant to thrive. The providers cited variations in policies and procedures, noting that available resources are stretched to the limit. While services are available for pregnant women, all too often they “shut down” after delivery.

“Our current focus on the period of pregnancy alone is insufficient to address the complexity of NAS,” the authors wrote, highlighting the need for programs and policy at each stage of the cascade, toward the critical goal of stemming the tide of NAS.

“Unless we make a serious political commitment to create fair drug policy, adapt a more integrative approach to addressing NAS, and adequately support the initiatives that we know can work, NAS incidence will continue to rise and devastate communities,” the authors concluded.