In the Literature

July 20, 2022

In the Literature...

Neonatal abstinence syndrome and mother’s own milk at discharge - OBJECTIVE: To describe factors impacting receipt of mother’s own milk (MOM) at discharge among California infants diagnosed with neonatal abstinence syndrome (NAS). CONCLUSION: Results suggest supporting the mother-infant dyad and using non-pharmacologic treatment methods, such as rooming-in, increase receipt of MOM at discharge.

Can Umbilical Cord and Meconium Results Be Directly Compared? Analytical Approach Matters - Maternal drug use during pregnancy is a significant concern. Drug-exposed newborns are often born premature and may suffer from birth defects, neonatal abstinence syndrome and cognitive and developmental delays. Because of this, testing of neonatal specimens is carried out to assess fetal drug exposure during pregnancy. Umbilical cord tissue (UC) and meconium are commonly used specimens for this purpose. However, comprehensive studies comparing drug positivity rates and concentration in the two specimen types are lacking. Utilizing a large retrospective cohort of paired meconium and UC specimens, we showed that meconium has a higher concentration of drugs. Despite this, drug positivity rates are higher in UC, due largely to differences in analytical approach at our institution, including much lower cut-off concentrations for UC than for meconium. Furthermore, the detection of different multidrug combinations detected in the two matrices underscores the fact that maternal factors, specimen characteristics and assay design should be considered when making a choice for specimen type for evaluating neonatal drug exposure.

Morphine versus methadone for neonatal opioid withdrawal syndrome: a randomized controlled pilot study - Neonatal Opioid Withdrawal Syndrome (NOWS) is a significant public health issue and while millions of neonates are affected each year, an optimal pharmacologic weaning protocol has yet to be demonstrated. In this study, we compare hospital length of stay (LOS) and length of treatment (LOT) for treatment of neonatal opioid withdrawal (NOWS) with morphine versus methadone. Conclusions: Infants treated with morphine versus methadone had no significant differences in LOS or LOT in this pilot study. Infants treated with methadone received up to 3 times the opioid based on morphine equivalents as infants treated with morphine and had more transfers to the NICU for over sedation.

You have to take this medication, but then you get punished for taking it:” lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period - Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes. Results: The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period.

Conclusions: Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery.

Cost-effectiveness of Treatments for Opioid Use Disorder - In this cost-effectiveness analysis, expanded access to MAT, combined with OEND and CM, was associated with cost-saving reductions in morbidity and mortality from OUD. Lack of widespread MAT availability limits access to a cost-saving medical intervention that reduces morbidity and mortality from OUD. Opioid overdoses in the US likely reached a record high in 2020 because of COVID-19 increasing substance use, exacerbating stress and social isolation, and interfering with opioid treatment. It is essential to understand the cost-effectiveness of alternative forms of MAT to treat OUD.

Call Proposals - PQCNC 2024

It's time for PQCNC to consider initiatives for launch in January of 2024.

What areas of perinatal care need attention and offer the greatest opportunities for improvement? In thinking about this consider large scale impact, the potential to pull together all newborn providers, or all maternal providers, or maternal and newborn providers in a project which allows partnership with patients and families as we seek to make North Carolina the best place to give birth and be born.

Consider the continuum of perinatal care. We are currently working in maternity clinics in clOUDi 2.0 and while it is a work in progress, we seek to continue evolving this pre and postnatal presence.

This is not a request for a white paper or detailed discussion of what your project might look like. We simply ask for a paragraph or two that addresses the key intervention opportunity and the impact it will have.

We will present these initiative proposals later in the year at our Annual Meeting on September 29th in Raleigh.

Submit your proposal

Registration is now open for the PQCNC Annual Meeting on September 29th at the McKimmon Center in Raleigh NC.

Come listen to speakers of general interest, proposals for new initiatives and then vote for what you think PQCNC should work on in 2024

Contact me!

Keith M Cochran

qiadvisor@pqcnc.org

984-974-7871

'Unoffice' hours - click here to schedule a Zoom meeting