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Rates of neonatal abstinence syndrome have increased in recent years, but a newer approach to infant care newborn babies exposed to opioids during pregnancy gets them out of the hospital sooner and with less medication, according to a study posted on sunday in New England Journal of Medicine.
Newborns with opioid withdrawal may experience stomach upset, inconsolable crying, seizures, and extreme discomfort. The study looked at the impacts of the Eat, Sleep, Console approach to care on 1,300 infants at 26 US hospitals and compared them to the current standard for the care of infants exposed to opioids.
Eat, Sleep, Console encourages parental involvement and prioritizes non-drug care, such as swaddling, skin-to-skin contact, and breastfeeding. The usual approach involves a nurse measuring a baby’s withdrawal symptoms, such as their level of irritability, crying tone, fever or tremors, before administering treatment such as methadone or morphine.
“Compared with usual care, use of the Eat, Sleep, Console approach to care substantially reduced the time until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes,” they wrote. the researchers in the study.
Babies evaluated with the Eat, Sleep, Console method of care were discharged after eight days on average, compared with almost 15 days for babies who were cared for with the standard approach, the researchers said. Additionally, infants in the Eat, Sleep, Console care group were 63% less likely to receive opioid medication: 19.5% received medication compared to 52% in the usual care group.
The current approach to usual care “is a very comprehensive, nurse-led way of assessing the baby, whereas the Eat, Sleep, Comfort approach involves the mother in the way she assesses the baby and allows the mother to participate in try to calm babies and see if the baby can be calmed or can eat or can sleep,” according to Rebecca Baker, director of the NIH HEAL Initiativewhich awards grants to researchers studying ways to alleviate the nation’s opioid health crisis.
“So in that way, it’s a little bit more functional, like looking at the abilities of the babies versus the severity of the effects of the baby.”
The results of the evaluation determine whether a baby should receive medication to control withdrawal symptoms, Baker said.
“So even with Eat, Sleep, Console, some babies who were exposed to a large amount of opioids during the mother’s pregnancy will still need medication-based treatment for withdrawal. It’s just that fewer of them need it and when they do need it, they need less medication to control withdrawal symptoms,” she said.
The Eat, Sleep, Console method was developed about eight years ago and some hospitals have already implemented it. But Baker said the study findings could change the way more hospitals care for babies with neonatal withdrawal syndrome, which occurs mostly in babies who have been exposed to opioids. while in the womb.
“The rise of the really strong fentanyl, the synthetic opioid, means that if a mother has used drugs during pregnancy, the baby will be exposed to more powerful drugs, which is likely to have an effect. We haven’t had a chance to study it in detail yet, but it will affect how they feel when they are born and separated from their mother,” Baker said.
The study findings, which were presented at the PAS 2023 meeting on Sunday, could have a major impact in hospitals by freeing up space for neonatal intensive care unit beds and boosting morale among nurses at risk of burnout.
“We trained more than 5,000 nurses as part of the study. They felt really empowered to help the mother take care of the baby to help the baby recover, and I think from a moral perspective that’s incredibly important and valuable,” Baker said. “And as you know, nurses are facing really severe staffing shortages and moral challenges, so it’s really important to have this tool available so that they can do something positive in the life of the baby and the connection with the mother.”
Researchers are currently following a subset of the babies in the study for up to two years to see how they grow and develop.
“One of the things that we want to be really sure about is that there are no negative consequences associated with taking less medication, so we’ll be looking for that,” Baker said.
The United States has seen an explosion in the number of babies born with neonatal abstinence syndrome in recent years, increasing by about 82% between 2010 and 2017, according to the US Centers for Disease Control and Prevention.. The number of opioid-related maternal diagnoses is also increasing, increasing by 131% over the same period.
Nearly 60 babies are diagnosed with NAS each day, according to data from the US Agency for Healthcare Research and Quality in 2020.
The opioid epidemic in the United States has expanded in recent years, and opioid deaths are the leading cause of accidental death in the US.
More than a million people have died from drug overdoses, mostly opioids, in the two decades since the US Centers for Disease Control and Prevention began collecting that data. Opioid overdose deaths rose more than 17% in just one year, from about 69,000 in 2020 to about 81,020 in 2021, the CDC found.
Most are adults, but children are dying too, much of it after taking synthetic opioids like fentanyl. Between 1999 and 2016, nearly 9,000 children and teens died from opioid poisoning, with the highest annual rates among teens ages 15 to 19, the CDC found.
The use of opioids during pregnancy has been linked to maternal mortality and the risk of overdose for the mother, According to the Centers for Disease Control and Preventionwhile babies are at risk of premature birth, low birth weight, respiratory problems and feeding problems.
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