The Clinical Challenges and Costs of Caring for Infants with Neonatal Opioid Withdrawal Syndrome (NOWS) in the Post-Nursery Period

护理产后新生儿阿片类药物戒断综合征 (NOWS) 婴儿的临床挑战和费用

• 批准号: 10664610
• 负责人: Julie Rozelle Gaither
• 金额: $ 16.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10664610
• 关键词: Accidental Injury; Address; Adolescent; Adult; Affect; Area; Attention; Autonomic nervous system; Award; Birth; Caring; Central Nervous System; Child; Child Abuse; Clinical; Community Healthcare; Development; Diagnosis; Disease; Eating; Epidemiologist; Evidence based intervention; Family; Female of child bearing age; Goals; Health Care Costs; Health Personnel; Healthcare; Helping to End Addiction Long-term; Home; Home visitation; Hospital Costs; Hospitalization; Hospitals; Infant; Infant Care; Injury; Intervention; Interview; Knowledge; Length of Stay; Life; Maternal complication; Medical; Mentorship; Mission; Modeling; Monitor; Mothers; National Institute of Child Health and Human Development; Neonatal Abstinence Syndrome; Newborn Infant; Opioid; Overdose; Parents; Pediatric Hospitals; Pediatric Nursing; Personal Satisfaction; Postpartum Period; Protocols documentation; Qualitative Research; Recovery; Research; Research Methodology; Resources; Risk; Safety; Site; Sleep; Social Workers; Stress; Structure; Substance Use Disorder; Time; Training; United States National Institutes of Health; Work; active method; care costs; career; career development; clinical care; cost; cost effective; design; economic evaluation; evidence base; experience; gastrointestinal; health data; high risk; high risk infant; hospital readmission; illicit opioid; implementation science; improved outcome; infancy; infant outcome; intersectionality; large datasets; maltreatment; maternal opioid use; maternal stress; medical schools; neglect; opioid epidemic; opioid use disorder; postnatal; prescription opioid; prevent; relapse risk; secondary analysis; skills; substance use

PROJECT SUMMARY The increased use of both prescription and illicit opioids among women of child-bearing age over the past two decades has resulted in a five-fold increase in neonatal opioid withdrawal syndrome (NOWS). The requisite monitoring and management of infants with NOWS prolong postnatal hospitalization, resulting nationally in hospital costs that currently exceed $560 million annually. Multiple approaches have been investigated to reduce the substantial care and cost burden of treating infants with NOWS postnatally, including through dyadic approaches such as the Eat, Sleep, Console protocol. Far less attention has been paid to understanding the clinical needs and subsequent trajectory of care for infants with NOWS during the remainder of their infancy— including their risk of hospital readmission and the associated costs. A clearer understanding of these issues is integral to developing protocols to assist mothers with opioid use disorder (OUD) in caring for their infants during a time when the health care needs of both the mother and the child are great. Mothers with OUD are at high risk of relapse and of overdose during the first postpartum year. In turn, the risk of abuse or neglect is highest for all children in the first year of life. Thus, the objective of this career development proposal is to understand the challenges of caring for infants with NOWS in the year following discharge from the birth hospitalization. The first study aims to quantify the risks and costs of hospital readmissions during the first year of life for infants with NOWS. The second study will focus on the challenges of keeping infants with NOWS healthy and safe in the year following discharge from the birth hospitalization, a vulnerable time for both mother and child. Long-term, my goal is to use these findings to inform the development of an evidence-based model of care within the home-visiting framework that addresses the unique needs of families affected by NOWS following discharge from the birth hospitalization. In applying for this award, I am seeking to develop the skills I need to successfully transition into the field of NOWS research. As an epidemiologist with a background in pediatric nursing, I have spent the past 12 years investigating the impact of the opioid crisis on adults (and to a lesser extent, children and adolescents) through secondary analyses of large datasets. I need further training related to 1) the clinical care of infants with NOWS and skillfully working with mothers with OUD, 2) economic evaluations, 3) qualitative research methods, and 4) implementation science. I have assembled a mentorship team led by experts in parental substance use and child abuse that addresses each area of training and leverages the resources available at Yale. The training and research outlined in this proposal promise to have a high impact on my career, as they will provide me with the skills and knowledge that I need to meet my long- term career goal of developing expertise in designing substance use interventions that are evidence-based, cost- effective, and informed by the lived experience of families.

项目摘要 在过去两年中，育龄妇女使用处方类阿片和非法类阿片的情况有所增加， 几十年来，新生儿阿片类药物戒断综合征（NOWS）增加了五倍。必要的 NOWS婴儿的监测和管理延长了产后住院时间，导致全国范围内 目前每年医院费用超过5.6亿美元。已经研究了多种方法来减少 出生后治疗NOWS婴儿的大量护理和费用负担，包括通过双 例如吃、睡、控制台协议。人们很少注意了解 NOWS婴儿在婴儿期剩余时间的临床需求和后续护理轨迹- 包括他们再次入院的风险和相关费用。对这些问题的更清晰的认识是 不可或缺的是制定协议，以帮助阿片类药物使用障碍（OUD）的母亲在 在这个时期，母亲和孩子的医疗保健需求都很大。患有OUD的母亲处于高风险之中 在产后第一年内复发和用药过量。反过来，虐待或忽视的风险是所有人最高的 孩子在生命的第一年。因此，本职业发展建议的目的是了解 在出生住院后出院的一年中，护理NOWS婴儿的挑战。第一 一项研究旨在量化婴儿在出生后第一年再次入院的风险和费用， 现在。第二项研究将集中在保持NOWS婴儿健康和安全的挑战上。 分娩后出院一年，这是母亲和婴儿的脆弱时期。 从长远来看，我的目标是利用这些发现为基于证据的护理模式的发展提供信息 在家访框架内，满足受NOWS影响家庭的独特需求， 从出生住院出院。在申请这个奖项，我寻求发展的技能，我需要 成功进入NOWS研究领域。作为一个有儿科背景的流行病学家 在过去的12年里，我一直在调查阿片类药物危机对成年人的影响（以及对较小的人的影响）。 程度，儿童和青少年）通过大型数据集的二次分析。我需要进一步的培训 1）NOWS婴儿的临床护理和与OUD母亲的熟练工作，2）经济 评价，3）定性研究方法，4）实施科学。我召集了一个导师团队 由父母使用药物和虐待儿童问题专家领导的小组，处理每个培训领域， 充分利用耶鲁大学的资源本提案中概述的培训和研究承诺将为 对我的职业生涯有很大的影响，因为他们将为我提供我需要的技能和知识，以满足我的长期- 长期职业目标是发展设计物质使用干预措施的专业知识，这些干预措施是以证据为基础的， 有效，并通过家庭的生活经验。