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

护理产后新生儿阿片类药物戒断综合征 (NOWS) 婴儿的临床挑战和费用

• 批准号: 10664610
• 负责人: Julie Rozelle Gaither
• 金额: $ 16.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10664610
• 关键词: Accidental Injury; Address; Adolescent; Adult; Affect; Area; Attention; Autonomic nervous system; Award; Birth; Caring; Central Nervous System; Child; Child Abuse; Clinical; Community Healthcare; Development; Diagnosis; Disease; Eating; Epidemiologist; Evidence based intervention; Family; Female of child bearing age; Goals; Health Care Costs; Health Personnel; Healthcare; Helping to End Addiction Long-term; Home; Home visitation; Hospital Costs; Hospitalization; Hospitals; Infant; Infant Care; Injury; Intervention; Interview; Knowledge; Length of Stay; Life; Maternal complication; Medical; Mentorship; Mission; Modeling; Monitor; Mothers; National Institute of Child Health and Human Development; Neonatal Abstinence Syndrome; Newborn Infant; Opioid; Overdose; Parents; Pediatric Hospitals; Pediatric Nursing; Personal Satisfaction; Postpartum Period; Protocols documentation; Qualitative Research; Recovery; Research; Research Methodology; Resources; Risk; Safety; Site; Sleep; Social Workers; Stress; Structure; Substance Use Disorder; Time; Training; United States National Institutes of Health; Work; active method; care costs; career; career development; clinical care; cost; cost effective; design; economic evaluation; evidence base; experience; gastrointestinal; health data; high risk; high risk infant; hospital readmission; illicit opioid; implementation science; improved outcome; infancy; infant outcome; intersectionality; large datasets; maltreatment; maternal opioid use; maternal stress; medical schools; neglect; opioid epidemic; opioid use disorder; postnatal; prescription opioid; prevent; relapse risk; secondary analysis; skills; substance use

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.

项目摘要 在过去的两个 几十年来，新生儿阿片类药物戒断综合征（现在）增加了五倍。必要的 现在延长产后住院的婴儿的监测和管理，在全国范围内导致 目前每年超过5.6亿美元的医院费用。已经研究了多种方法以减少 现有现象在现有现象中治疗婴儿的大量护理和成本燃烧，包括通过二元 饮食，睡眠，控制台协议等方法。对了解 在其余的婴儿期间，临床需求和随后对现在患有现在的婴儿的护理轨迹 - 包括他们的住院再入院风险和相关费用。对这些问题的更清楚的理解是 开发方案的不可或缺的一部分，以协助母亲患有阿片类药物使用障碍（OUD）的母亲在照顾婴儿期间 母亲和孩子的卫生保健需求都很大的时候。 OUD的母亲有高风险 在产后的第一个年份中接力和过量。反过来，虐待或忽视的风险最高 儿童生命的第一年。这是这项职业发展建议的目标是了解 出生住院后一年，照顾婴儿的挑战。第一个 研究旨在量化婴儿第一年的医院再入院的风险和成本 现在。第二项研究将重点介绍使婴儿在健康中保持健康和安全的挑战 出生住院后出院后的一年，母亲和儿童都是脆弱的时间。 长期，我的目标是使用这些发现来告知基于证据的护理模型 在家庭访问的框架内，该框架解决了受现在影响的家庭的独特需求 出生住院。在申请该奖项时，我正在寻求发展我需要的技能 成功地过渡到Nows研究领域。作为具有儿科背景的流行病学家 护士，我已经花了12年来调查阿片类药物危机对成年人的影响（对较少的成年人 范围，儿童和青少年）通过大型数据集的次要分析。我需要进一步的培训 到1）婴儿的临床护理，并熟练地与Oud的母亲一起工作，2）经济 评估，3）定性研究方法，4）实施科学。我已经组装了心态。 由父母物质使用和虐待儿童专家领导的团队，这些团队涉及培训的每个领域， 利用耶鲁大学可用的资源。该提案中概述的培训和研究承诺 对我的职业的影响很大，因为它们将为我提供我需要长期的技能和知识 培养专业知识在设计物质使用干预措施方面的职业目标，这些干预措施是基于证据的，成本 - 有效，并由家庭的现场经验告知。