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: 10651803
• 负责人: Ekaterina Burduli
• 金额: $ 16.94万
• 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/10651803
• 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; Learning; Learning Module; Length; Length of Stay; Long-Term Care; 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; 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; Risk Reduction; Shapes; Sleep; Stress; Structure; Substance Use Disorder; Surveys; Sweating; Symptoms; Testing; Training; Training Activity; Tremor; Woman; Work; analog; arm; 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; pharmacologic; poor health outcome; pregnant; prescription opioid; prevent; product development; programs; readmission rates; skills; skills training; substance use; sucking; technology platform; 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