A Proactive Treatment Approach for Opioid-Dependent Babies

The Problem: 
Babies that are born opioid-dependent as a result of maternal opioid replacement therapy while pregnant often develop Neonatal Abstinence Syndrome (NAS). This drug withdrawal syndrome can have devastating effects, including severe pain, tremors, crying, difficulty sleeping, feeding problems, vomiting, liquid diarrhea and extreme weight loss. With opioid use disorders still growing rapidly in South Carolina and across the nation, this is an emerging crisis.

The Goal: 
To develop a treatment approach that minimizes the likelihood of babies experiencing the severe effects associated with NAS.

Method & Implementation:
Greenville Health System (GHS) worked with Clemson University to study an innovative early-therapy method that proactively targets the symptoms of NAS. With funding support from the SC Department of Health and Human Services, GHS and Clemson researchers first analyzed the safety, efficacy and cost of the approach, publishing their findings in the American Journal of Perinatology (December 2016) and Population Health Management (May 2017).  A multi-year retrospective comparison study will appear in the upcoming issue of The Joint Commission Journal on Quality and Patient Safety (June 2018).

Their studies describe outcomes associated with the Managing Abstinence in Newborns (MAiN) Program, which was designed at GHS to minimize the likelihood of babies experiencing the severe pain, suffering and potential health complications that come with full withdrawal. Qualified opioid dependent babies are given low-dose medication within 24 hours of birth rather than waiting for symptoms to escalate. Babies in the MAiN program can be treated in-room with their mothers rather than in the neonatal intensive care unit (NICU) and typically stay in the hospital for just a week, rather than for weeks or months typically associated with NICU NAS care. They are then gradually weaned off the medication over two to four weeks post-discharge.

Challenges & Barriers:
Because of the ambition of achieving true culture change, Rautenberg ran into some unexpected hurdles in implementing this new process. While non-clinical staff were often quite enthusiastic about their new roles, patients would often be uncertain about nonclinical staff answering their call alerts. And non-clinical staff was often put into a bind when the room communication boards, which provided the necessary information when looking for support, were often out-of-date. This led to some additional apprehensiveness if the ad-hoc caregiver appeared confused or uncertain.

Results:
Babies treated in the MAiN program from 2006-2014 saw no increases in emergency department visits or readmission rates. GHS and Clemson believe that expanding the program within SC will save millions in expenditures over the next five years by reducing NICU time. In the studied cohort, average charges for NAS infants in the MAiN program at GHS were under $11,000, compared to an average of $45,000 for traditional-care NAS infants statewide and almost $60,000 for NAS infants nationwide.

For more information about this story or to tell us about your own best practices, email us at stories@scha.org.