Effective Caregiving for Neonatal Abstinence Syndrome: Development of an Instructional Mobile Technology Platform for High-Risk Pregnant Women

新生儿禁欲综合症的有效护理：为高危孕妇开发教学移动技术平台

• 批准号: 10424451
• 负责人: Ekaterina Burduli
• 金额: $ 16.49万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424451
• 关键词: Address; Admission activity; Affect; American College of Obstetricians and Gynecologists; Anxiety; Birth; Body Weight decreased; Breast Feeding; Caregivers; Caring; Child; Consultations; Cues; Data; Development; Discipline of obstetrics; Eating; Education; Environment; Epidemiology; Feeling; Fever; Future; General Population; Goals; Health; Health Technology; Hospitals; Industry; Industry Collaboration; Infant Care; Instruction; Intervention; Interview; Lead; Learning; Learning Module; Length; Length of Stay; Maternal Health; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Modification; Mothers; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Neonatology; Newborn Infant; Outcome; Perception; Pharmacology; Pilot Projects; Positioning Attribute; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Provider; Randomized; Readiness; Recommendation; Recovery; Relapse; Research; Research Personnel; Research Support; Risk; Shapes; Sleep; Stress; Structure; Substance Use Disorder; Surveys; Sweating; Symptoms; Testing; Training; Training Activity; Tremor; Woman; Work; analog; arm; base; care providers; career; career development; caregiver education; caregiving; clinical trial implementation; design; drug relapse; efficacy testing; evidence base; experience; feeding; follow-up; high risk; high risk population; high standard; hospital readmission; illicit opioid; improved; innovation; interactive tool; mHealth; maternal risk; maternal safety; mobile computing; neonatal health; obstetric care; opioid agonist therapy; opioid treatment program; opioid use; opioid use disorder; opioid withdrawal; perinatal women; pregnant; prescription opioid; prevent; product development; programs; readmission rates; skills; skills training; substance use; sucking; tool; treatment adherence; treatment arm; treatment as usual; usability; virtual

ABSTRACT Due to an alarming rise in opioid use among the general population that is mirrored in pregnant women, Neonatal Abstinence Syndrome (NAS) rates have increased in the US from 2004 to 2014. Most newborns experiencing NAS require non-pharmacologic care, which entails, most importantly, maternal involvement with her newborn. Facilitating postpartum maternal-newborn involvement is critical in preventing further adverse maternal-newborn outcomes. To achieve positive maternal-newborn involvement, mothers need to learn effective caregiving NAS strategies while they are pregnant. Surprisingly, current obstetrical practice standards for high risk pregnant women do not address this pressing need, in part because no interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. To address this critical gap, I propose to adapt an existing mobile NAS tool for clinician training and decision support, for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled analog trial. First, I will conduct semi- structured interviews with a panel of neonatology experts, NAS care providers, and mothers with NAS-affected babies to gather their recommendations on management of NAS and explore their perspectives on the care of these newborns. Findings will guide the adaptation of the existing mobile NAS tool for high-risk pregnant women. I will then test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT) at Spokane Regional Health District’s Opioid Treatment Program and Evergreen Recovery Center. Finally, we will randomize 30 high-risk pregnant women seen at these facilities to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these mothers on maternal drug relapse and OAT continuation, maternal-newborn bonding, length of newborn hospital stays, readmissions rates, breastfeeding initiation and duration, and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Findings will serve as pilot data for a subsequent large R01 randomized controlled analog trial testing the efficacy of the adapted NAS caregiving tool in reducing poor outcomes for NAS-affected newborns and their mothers. My proposed research plan integrates activities, formal training, and mentorship from experts (Drs. Sterling McPherson, Hendree Jones, John Roll, Celestina Barbosa-Leiker, and Kim Johnson) in development, testing and implementation of substance use disorder treatment for perinatal women, mobile health interventions, and implementation of clinical trials in perinatal women with substance use disorders. This Mentored Research Scientist Development Award (K01) will build upon my previous training and allow me to pursue my long-term career goal of becoming an independent investigator with an established program of research focused on the development, implementation, and testing of interventions for substance using perinatal women and reduction of poor health outcomes for substance using perinatal women and their newborns.

摘要 由于普通人群中阿片类药物使用量的惊人上升，孕妇的情况也是如此，新生儿 从2004年到2014年，美国的禁欲综合症(NAS)患病率有所上升。大多数新生儿都经历了 NAS需要非药物护理，最重要的是，这需要母亲与她的新生儿一起参与。 促进产后孕产妇-新生儿的参与对于预防进一步的不良孕产妇-新生儿至关重要 结果。为了实现积极的母婴参与，母亲们需要学习有效的护理NAS 在她们怀孕期间采取的策略。令人惊讶的是，目前针对高危孕妇的产科实践标准 妇女没有解决这一紧迫需求，部分原因是没有干预措施为未来的母亲做好准备 NAS面临的照顾面临风险的新生儿的挑战。为了解决这一关键差距，我建议调整一种 用于临床医生培训和决策支持的现有移动NAS工具，适用于高危孕妇，并评估其 一项小型随机对照模拟试验的可用性、可接受性和可行性。首先，我将进行半- 对新生儿专家、NAS护理提供者和受NAS影响的母亲的结构化访谈 收集婴儿对NAS管理的建议，并探讨他们对NAS护理的看法 这些新生儿。研究结果将指导现有的移动NAS工具适用于高危孕妇。 然后，我将通过对10名孕妇的调查，测试调整后的移动工具的可用性、可接受性和可行性 在斯波坎地区卫生区阿片类药物治疗计划中接受阿片激动剂治疗(OAT)的妇女 和常青树康复中心。最后，我们将对在这些设施中看到的30名高危孕妇进行随机选择 接受适配的移动NAS护理工具或常规护理。我们会比较这些母亲的 母体药物复发和燕麦片持续，母婴结合，新生儿住院时间， 4、8和12岁时的再住院率、母乳喂养开始和持续时间以及产后抑郁和焦虑 产后几周。研究结果将作为后续大型R01随机对照模拟试验的试点数据 试验测试调整后的NAS护理工具在减少受NAS影响的不良结局方面的有效性 新生儿和他们的母亲。我建议的研究计划包括活动、正式培训和指导 来自专家(斯特林·麦克弗森博士、亨德里·琼斯博士、约翰·罗尔博士、塞莱斯蒂娜·巴博萨-莱克博士和金·约翰逊博士) 为围产期妇女开发、测试和实施药物使用障碍治疗，流动 健康干预，以及对患有药物使用障碍的围产期妇女进行临床试验。这 导师研究科学家发展奖(K01)将建立在我之前培训的基础上，并允许我 追求我的长期职业目标，成为一名独立调查员，并建立一个 研究的重点是制定、实施和测试围产期使用物质的干预措施 减少使用药物的围产期妇女及其新生儿的不良健康结果。