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 al 4 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 (ESC) assessment tool, and decreasing the use of opiate therapy. Impressively, with implementation of their care standardization approach, they were able to meet all 3 aims. They decreased the average LOS for OENs from a baseline of 15.9 to 7.5 days and decreased the average LOS for those newborns who required pharmacologic therapy from 19.2 to 11.5 days. They also demonstrated a decrease in the percentage of OENs who received pharmacologic therapy from a preintervention mean of 55.1% to 22.6%.Despite the strengths of this study, which include a large sample size over multiple hospitals, there are clear limitations. First, as the authors acknowledge, there are relatively few data points representing the initial baseline, raising a potential concern that this may not have been an accurate portrayal of the system before the initiative. In