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

项目概要/摘要 这个K 08职业发展建议的长期目标是促进我在围产期健康方面的培训 服务研究，目标是改善物质暴露的母婴二人组的健康。 我的新技能和经验将在1）复杂数据集的管理; 2）多层次和 三角分析; 3）实施战略设计和测试;以及4）政策领导 参与和影响。该研究提案的目的是寻求改善阿片类药物的结果， 通过改进母乳喂养和皮肤接触护理做法，减少接触过艾滋病毒/艾滋病的婴儿。非药物 这些方法被认为是接触阿片类药物的婴儿的主要治疗方法。然而，许多使用阿片类药物的妇女 不适合母乳喂养且低于50%者开始，产后6天内停止。阿片类- 暴露的婴儿容易出现戒断症状，导致住院时间延长，暴露 药物治疗，增加了住院费用。众所周知，母乳喂养和皮肤接触 皮肤护理可以减少新生儿戒断症状的严重程度和数量，改善母婴联系 以及缩短停留时间和降低成本。尽管有这些好处，母乳喂养和皮肤接触 比率仍然非常低，不清楚为什么没有广泛执行。可能是因为 大多数实现努力集中在临床医生活动（例如，评估、诊断、药理学 治疗），而不是对母亲及其对新生儿的照顾。为了更好地了解 母乳喂养和皮肤接触作为阿片类药物暴露婴儿治疗的结构和个人障碍， 一项拟议的5年研究将使用混合方法检查影响母乳喂养和皮肤接触的因素。 方法设计本研究共招募了四家医院，收集了与产妇有血缘关系的病历资料， 婴儿二元组（N=360），来自临床医生的调查数据（预期N=513），以描述和探索相关 实施因素，以及来自阿片类药物暴露母亲的纵向半结构化访谈数据（N=30）。 目的1详细研究母亲、新生儿和单位环境因素对母乳喂养和皮肤接触的影响 使用三角测量和多层次分析法治疗阿片类药物暴露的婴儿。Aim 2检测并 询问实施促进者，障碍，和战略有关的实施孕产妇- 使用半结构化的母亲访谈，数据三角测量和理论知情 实现映射。目标3开展试点执行战略，并评价执行情况和护理 交付成果。这些目标的完成为R 01提案提供了必要的培训和数据。这 该提案与NICHD目前在解决新生儿疾病方面的投资具有协同作用和独特的互补性。 阿片类药物戒断正式培训计划在Vanessa道尔顿博士的指导下进行， 相关的方法和内容专业知识。培训将补充我在实施科学方面的专业知识， 解决培训差距，并为拟议研究的成功和公共卫生影响做出贡献。

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.