clOUDi 3.0 updates newsletter

August 16, 2023

A mini review of what matters in the management of NAS, is ESC the best care? - The interventions that appear to ameliorate the effects of maternal drug use include the following: access to prenatal care as well as to treatment programs and mitigation of polysubstance use paired with identification and intervention of adverse Social Determinants of Health; for hospitals that manage infants with NAS, an established protocol to define, promptly initiate and reinforce non-pharmacological interventions, and, if needed, continuous cardiorespiratory monitoring of infants that require pharmacotherapy while facilitating rooming-in (38) and breastfeeding when appropriate (42); and prompt follow-up needs to be established to ensure that any nutritional, growth, and/or neurodevelopmental challenges are rapidly identified and intervened.

Characteristics and outcomes of neonatal opioid withdrawal syndrome in preterm infants: a retrospective cohort study in the current era - Preterm and LPT infants have lower Finnegan scores and require less pharmacologic therapy for NOWS. It is unclear if this is because our current assessment tool does not capture their symptoms or if they truly have less withdrawal. Onset of NOWS is similar in LPT and term infant, thus LPT infants do not require prolonged hospital monitoring for NOWS.

Neonatal Abstinence Syndrome in Infants with Prenatal Exposure to Methadone versus Buprenorphine - The incidence of NAS was higher in infants exposed to methadone in utero compared to those exposed to buprenorphine. However, among neonates who required treatment for NAS, there was no significant difference in the severity of NAS, duration of medical treatment or length of stay between the groups. Treating pregnant women with buprenorphine decreased the risk of the baby developing NAS; however, once NAS treatment was initiated, the type of maternal prenatal exposure was not relevant.

Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016–2020 Transformed Medical Statistical Information System - Estimated rate of NAS has declined nationally, but rate of prenatal substance exposure has increased, with con- siderable state-level variation. The reported increase in prenatal substance exposure in the majority of US states (38) suggest that substances other than opioids are influencing this trend. Medicaid-led initiatives can be used to identify women with substance use and connect them to services.

Reminder to Register for Learning Session 3

Make sure your team is registered for Learning Session 3, Thursday, September 28, 2023 at the McKimmon Center - as you may recall in Learning Session 2 in April we collectively agreed that as part of LS3 and to celebrate 3 years of intensive work teams would bring at least one patient / parent / family member impacted by our work to this final learning session.

For those folks you will be bringing with your team please - 

• Make sure they also register (or register them yourself) to ensure an accurate count for the meeting space, breakfast, and lunch
• PQCNC is offering an honorarium for those patient / parent / family members that attend but to receive it there is paperwork that must be completed in advance of the meeting - either send us the contact information or have them reach out to qiadvisor@pqcnc.org directly

As a state we have an opportunity to participate in a national survey about hospital practices and protocols related to birthing person and newborn toxicology testing.

Here's the details - 

The survey is web-based and should be completed by individuals familiar with their hospital’s toxicology testing practices, including OB/GYN and pediatric physicians or fellows, certified nurse midwives (CNM), perinatal social workers, as well as L&D nursing managers. Importantly, only one individual at each hospital should complete the survey. The survey takes approximately 20 minutes to complete and participants will be entered into a raffle to win AirPods.

You can access the survey at the following link: https://redcap.link/dzx3f7fg

Your participation in this survey will not only provide PQCNC with valuable statewide data, but it will also advance research and advocacy related to toxicology testing practices during pregnancy, more broadly, and finally, data from other states will be shared with PQCNC which we can in turn share with you. 

Note: the introduction to the survey says that "your name and email address have been furnished to us by your PQC" - this is not the case as we are only sharing the survey link with y'all - we NEVER share names and email addresses