Effective Caregiving for Neonatal Abstinence Syndrome: Development of an Instructional Mobile Technology Platform for High-Risk Pregnant Women

新生儿禁欲综合症的有效护理：为高危孕妇开发教学移动技术平台

• 批准号: 10198895
• 负责人: Ekaterina Burduli
• 金额: $ 16.09万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10198895
• 关键词: Address; Admission activity; Affect; American College of Obstetricians and Gynecologists; Anxiety; Birth; Body Weight decreased; Breast Feeding; Caregivers; Caring; Child; Consultations; Cues; Data; Development; Discipline of obstetrics; Eating; Education; Environment; Epidemiology; Feeling; Fever; Future; General Population; Goals; Health; Health Technology; Hospitals; Industry; Industry Collaboration; Infant Care; Instruction; Intervention; Interview; Lead; Learning; Learning Module; Length; Length of Stay; Maternal Health; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Modification; Mothers; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Neonatology; Newborn Infant; Outcome; Perception; Pharmacology; Pilot Projects; Positioning Attribute; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Provider; Randomized; Readiness; Recommendation; Recovery; Relapse; Research; Research Personnel; Research Support; Risk; Shapes; Sleep; Stress; Structure; Substance Use Disorder; Surveys; Sweating; Symptoms; Testing; Training; Training Activity; Tremor; Woman; Work; analog; arm; base; care providers; career; career development; caregiver education; caregiving; clinical trial implementation; design; drug relapse; efficacy testing; evidence base; experience; feeding; follow-up; high risk; high risk population; high standard; hospital readmission; illicit opioid; improved; innovation; interactive tool; mHealth; maternal risk; maternal safety; mobile computing; neonatal health; obstetric care; opioid agonist therapy; opioid treatment program; opioid use; opioid use disorder; opioid withdrawal; perinatal women; pregnant; prescription opioid; prevent; product development; programs; readmission rates; skills; skills training; substance use; sucking; tool; treatment adherence; treatment arm; treatment as usual; usability; virtual

ABSTRACT Due to an alarming rise in opioid use among the general population that is mirrored in pregnant women, Neonatal Abstinence Syndrome (NAS) rates have increased in the US from 2004 to 2014. Most newborns experiencing NAS require non-pharmacologic care, which entails, most importantly, maternal involvement with her newborn. Facilitating postpartum maternal-newborn involvement is critical in preventing further adverse maternal-newborn outcomes. To achieve positive maternal-newborn involvement, mothers need to learn effective caregiving NAS strategies while they are pregnant. Surprisingly, current obstetrical practice standards for high risk pregnant women do not address this pressing need, in part because no interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. To address this critical gap, I propose to adapt an existing mobile NAS tool for clinician training and decision support, for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled analog trial. First, I will conduct semi- structured interviews with a panel of neonatology experts, NAS care providers, and mothers with NAS-affected babies to gather their recommendations on management of NAS and explore their perspectives on the care of these newborns. Findings will guide the adaptation of the existing mobile NAS tool for high-risk pregnant women. I will then test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT) at Spokane Regional Health District’s Opioid Treatment Program and Evergreen Recovery Center. Finally, we will randomize 30 high-risk pregnant women seen at these facilities to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these mothers on maternal drug relapse and OAT continuation, maternal-newborn bonding, length of newborn hospital stays, readmissions rates, breastfeeding initiation and duration, and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Findings will serve as pilot data for a subsequent large R01 randomized controlled analog trial testing the efficacy of the adapted NAS caregiving tool in reducing poor outcomes for NAS-affected newborns and their mothers. My proposed research plan integrates activities, formal training, and mentorship from experts (Drs. Sterling McPherson, Hendree Jones, John Roll, Celestina Barbosa-Leiker, and Kim Johnson) in development, testing and implementation of substance use disorder treatment for perinatal women, mobile health interventions, and implementation of clinical trials in perinatal women with substance use disorders. This Mentored Research Scientist Development Award (K01) will build upon my previous training and allow me to pursue my long-term career goal of becoming an independent investigator with an established program of research focused on the development, implementation, and testing of interventions for substance using perinatal women and reduction of poor health outcomes for substance using perinatal women and their newborns.

抽象的 由于孕妇反映的一般人群中的Oioid使用令人震惊，新生儿 从2004年到2014年，美国的禁欲综合征（NAS）率上升。大多数新生儿体验 NAS需要非药物护理，最重要的是，这需要母校参与她的新生儿。 促进产后Matal-Newborn参与对于防止进一步的不良Matal-Newborn至关重要 结果。为了获得积极的母校参与，母亲需要学习有效的护理NAS 策略在怀孕时。令人惊讶的是，当前高风险怀孕的产科实践标准 妇女没有满足这种紧迫的需求，部分是因为没有干预措施为未来的母亲做好准备 照顾新生儿面临NAS风险的挑战。为了解决这个关键的差距，我建议适应 现有用于临床培训和决策支持的移动NAS工具，用于高风险孕妇和评估 在一项小型随机控制模拟试验中可用性，可接受性和可行性。首先，我将进行半 与新生儿专家，NAS护理提供者和受NAS影响的母亲的结构化访谈 婴儿收集有关NAS管理的建议，并探索他们对照顾的观点 这些新生儿。调查结果将指导现有的高危孕妇的现有移动NAS工具。 然后，我将通过10个怀孕的调查测试改编的移动工具的可用性，可接受性和可行性 在斯波坎地区卫生区的阿片类药物治疗计划中接受阿片类激动剂治疗（OAT）的妇女 和常绿恢复中心。最后，我们将在这些设施中随机分配30名高危孕妇 要么接收改编的移动NAS护理工具或通常的护理。我们将与这些母亲进行比较 母体药物接力和燕麦延续，孕产妇纽带，新生儿住院时间长度， 再入院率，母乳喂养倡议和持续时间，以及4、8和12的产后抑郁和动画 产后周。调查结果将用作随后的大型R01随机控制模拟的试验数据 试验测试改编的NAS护理工具在降低受NAS影响不佳的结果方面的效率 新生儿及其母亲。我提出的研究计划整合了活动，正规培训和精神训练 来自专家（Sterling McPherson博士，Hendree Jones，John Roll，Celestina Barbosa-Leiker和Kim Johnson） 在开发，测试和实施对围产期妇女的物质使用障碍治疗的过程中 健康干预措施，并在患有药物使用障碍的围产期妇女中实施临床试验。这 指导的研究科学家发展奖（K01）将在我以前的培训基础上，并让我 追求我的长期职业目标，即成为一个既定计划的独立调查员 研究重点是使用围产期的干预措施的开发，实施和测试 妇女使用围产期妇女及其新生儿的妇女和较差的健康结果。