Mom is medicine: Implementing maternal-delivered nonpharmacologic care for neonatal opioid withdrawal

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PROJECT SUMMARY/ABSTRACT The long-term goal of this K08 career development proposal is to advance my training in perinatal health services research with the goal of improving the health of substance-exposed, maternal-infant dyads. My new skills and experiences will be in 1) management of complex datasets; 2) multilevel and triangulation analytics; 3) implementation strategy design and testing; and 4) leadership for policy engagement and impact. The aims of the research proposal seek to improve outcomes of opioid- exposed infants by improving breastfeeding and skin-to-skin care practices. Nonpharmacologic approaches are considered primary treatment for opioid-exposed infants. However, many opioid-using women eligible to breastfeed do not and less than 50% of those who start, stop within six days postpartum. Opioid- exposed infants are vulnerable to withdrawal symptoms, resulting in longer lengths of hospitalization, exposure to pharmacologic treatment, and increased hospital costs. It is well-recognized that breastfeeding and skin-to- skin care can reduce severity and number of neonatal withdrawal symptoms, improve maternal-infant bonding as well as decrease lengths of stay and reduce costs. Despite these benefits, breastfeeding and skin-to-skin rates remain remarkably low and it is unclear why they have not been broadly implemented. It may be because most implementation efforts have focused on clinician activities (e.g., assessment, diagnosis, pharmacologic treatment) and not on mothers and their care for their newborns. Toward the goal of better understanding the structural and personal barriers to breastfeeding and skin-to-skin as treatment for opioid-exposed infants, the proposed 5-year study will examine factors affecting breastfeeding and skin-to-skin practices using a mixed methods design. Four hospitals have been recruited for collection of medical record data from linked maternal- infant dyads (N=360), survey data from clinicians (N=513 anticipated) to describe and explore relevant implementation factors, and longitudinal semi-structured interview data from opioid-exposed mothers (N=30). Aim 1 scrutinizes the effects of maternal, neonatal, and unit context factors on breastfeeding and skin-to-skin care to treat opioid-exposed infants using method triangulation and multilevel analytics. Aim 2 detects and interrogates the implementation facilitators, barriers, and strategies relevant to implementation of maternal- delivered care using semi-structured interviews with mothers, data triangulation and theory-informed implementation mapping. Aim 3 conducts a pilot implementation strategy and evaluates implementation and care delivery outcomes. Completion of these aims provides the requisite training and data for an R01 proposal. This proposal is synergistic and uniquely complimentary with NICHD’s current investment in addressing neonatal opioid withdrawal. Formal training is planned under the mentorship of Dr. Vanessa Dalton and co-mentors with relevant methodologic and content expertise. Training will complement my expertise in implementation science, address training gaps, and contribute to the success and public health impact of the proposed research.