The Triple Aim for Neonatal Abstinence Syndrome

Abstract

For decades, the diagnosis of neonatal abstinence syndrome (NAS) was relatively rare in the US; however, the recent epidemic of prescription and nonprescription opioid use across the country has made this once novel diagnosis common.1 The number of infants diagnosed with NAS in the US has grown nearly 5-fold since 2000. Today, one infant with NAS is born every 25 minutes, accounting for an estimated $1.5 billion in hospital charges.2 The rapid rise of NAS in our nurseries and neonatal intensive care units demands that improvements in research and care delivery systems keep pace.

Dynamics of Parental Opioid Use and Children's Health and Well-Being: An Integrative Systems Mapping Approach

“…Opioid use and medication-assisted treatment for OUDs during pregnancy can lead to neonatal abstinence syndrome or neonatal opioid withdrawal syndrome, specific to opioids, in some newborns (Substance Abuse and Mental Health Services Administration (SAMHSA), 2016 ). Infants with NAS often are born with low birth weights (Creanga et al, 2012 ; Patrick, 2015 ), may experience muscle rigidity, tremors, seizures, difficulty feeding, and be unable to regulate their core body temperature (Substance Abuse and Mental Health Services Administration (SAMHSA), 2016 ; Ko et al, 2017 ; Lynch et al, 2018 ). Infants prenatally exposed to opioids are often born pre-term and/or with low-birth weights, which may in turn contribute to a higher chance of developing long-term outcomes including cerebral palsy, developmental delays, and learning and behavioral problems (U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA), 2014 ).…”

It Is Time to ACT NOW to Improve Quality for Opioid-Exposed Infants

“…Improving care for opioidexposed infants must begin with defining and validating potential measures to assess hospital care practices and determining what aspect of quality a given measure assesses. 9 For many years, the literature has demonstrated variability in care delivered to opioid-exposed infants and has proposed frameworks to address such variations 10 ; however, there is no evidence of substantial improvement in care delivered to opioid-exposed infants. To achieve change, there must be a coordinated approach to incentivize high-quality care.…”

The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its’ Origins, Assessment, and Management

“…Recommendations for the pharmacological treatment of NAS, when indicated, need to come from randomized clinical trials with regard to which treatment to initially provide, how to escalate the dose and how to wean the medication(s), taking into consideration the safest time to be discharged home ( 32 , 49 ). The current lack of education of the many disciplines involved in the assessment and treatment of drug dependence during pregnancy and NAS, makes it difficult for clinicians and researchers to approach this epidemic and to avoid the potential detrimental consequences to this maternal/infant dyad ( 27 , 31 , 69 , 85 ). Clinicians, researches, and government funding agencies need to combine their expertise to provide adequate education and treatment protocols for drug dependent pregnant women and their infants with NAS.…”