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

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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.