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

项目总结 过去两年育龄妇女中处方和非法阿片类药物的使用增加 几十年来，新生儿阿片类药物戒断综合征(NOWS)增加了五倍。必备条件 对NOWS婴儿的监测和管理延长了出生后住院时间，导致全国 目前每年的医院费用超过5.6亿美元。已经对多种方法进行了调查，以减少 出生后治疗NOWS婴儿的大量护理和费用负担，包括通过二元治疗 方法，如EAT、睡眠、控制台协议。然而，人们对理解 婴儿期NOWS婴儿的临床需求和后续护理轨迹- 包括他们再次住院的风险和相关费用。对这些问题的更清晰的理解是 帮助患有阿片类药物使用障碍(OUD)的母亲在 一个母亲和孩子的保健需求都很大的时期。患有多发性硬化症的母亲处于高危状态 在产后第一年的复发和过量用药。反过来，滥用或忽视的风险对所有人来说都是最高的 儿童在生命的第一年。因此，这份职业发展提案的目标是了解 在出生住院出院后的一年内照顾患有NOWS的婴儿面临的挑战。第一 这项研究旨在量化婴儿在生命的第一年期间再次住院的风险和成本 好了。第二项研究将集中在如何使NOWS婴儿保持健康和安全的挑战。 出生住院后一年，对母亲和孩子来说都是脆弱的时期。 从长远来看，我的目标是利用这些发现为循证护理模式的发展提供信息 在家访框架内，满足受NOWS影响的家庭的独特需求如下 从出生住院出院。在申请这一奖项时，我希望发展我所需要的技能 成功过渡到NOWS研究领域。作为一名具有儿科背景的流行病学家 护理，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(以及较小的 通过对大数据集进行二次分析，对儿童和青少年的数据进行了统计分析。我需要进一步的相关培训 1)NOWS患儿的临床护理及与母婴的巧妙配合；2)经济 评价，3)质的研究方法，4)实施科学。我已经召集了一位导师 由父母药物使用和虐待儿童方面的专家领导的团队，解决每个领域的培训和 充分利用耶鲁大学现有的资源。这项提案中概述的培训和研究承诺将有一个 对我的职业生涯有很大的影响，因为他们将为我提供满足我长期工作需要的技能和知识 职业生涯目标是在设计物质使用干预措施方面发展专业知识，这些干预措施是以证据为基础的，成本- 有效，并从家庭的生活经验中获得信息。

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.