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

项目摘要/摘要 K08职业发展计划的长期目标是推进我在围产期健康方面的培训 服务于研究，目标是改善暴露于物质的母婴二人组的健康。 我的新技能和经验将在1)管理复杂的数据集；2)多层次和 三角分析；3)实施战略设计和测试；4)政策领导 参与度和影响力。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对皮肤护理做法，使婴儿暴露在风险中。非药理学 方法被认为是阿片类药物暴露婴儿的主要治疗方法。然而，许多使用阿片类药物的女性 有资格母乳喂养的人不能和不到50%的人在产后六天内开始、停止母乳喂养。阿片类药物- 接触过的婴儿容易出现戒断症状，导致住院时间更长，接触 药物治疗，并增加了医院费用。众所周知，母乳喂养和皮肤接触 皮肤护理可以减轻新生儿戒断症状的严重程度和数量，改善母婴纽带 以及减少停留时间和降低成本。尽管有这些好处，母乳喂养和皮肤对皮肤 利率仍然非常低，目前还不清楚为什么它们没有得到广泛实施。这可能是因为 大多数实施工作都侧重于临床医生的活动(例如，评估、诊断、药理学 治疗)，而不是母亲及其对新生儿的照顾。朝着更好地理解 母乳喂养和皮肤对皮肤接触阿片类药物的婴儿治疗的结构性和个人障碍， 拟议的为期5年的研究将检查影响母乳喂养的因素和皮肤对皮肤的做法，使用混合 方法设计。已招募了四家医院收集相关母亲的病历数据- 婴儿二联体(N=360)，来自临床医生的调查数据(N=513预期)，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仔细研究母亲、新生儿和单位环境因素对母乳喂养和皮肤接触的影响 使用三角测量和多水平分析的方法治疗接触阿片类药物的婴儿。AIM 2检测到并 询问与实施孕产妇--相关的实施促进者、障碍和战略 使用与母亲的半结构化访谈、数据三角和理论知识提供护理 实现映射。目标3实施试点实施战略，并评估实施和护理 分娩结果。这些目标的完成为R01提案提供了必要的培训和数据。这 该提案与NICHD目前在解决新生儿问题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 Dalton博士的指导下进行，与 相关的方法和内容方面的专门知识。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.