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: 10424451
• 负责人: Ekaterina Burduli
• 金额: $ 16.49万
• 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/10424451
• 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 由于普通人群中阿片类药物的使用量惊人增加，孕妇、新生儿 从 2004 年到 2014 年，美国的禁欲综合症 (NAS) 发病率有所上升。大多数新生儿都经历过 NAS 需要非药物护理，最重要的是，需要母亲参与新生儿护理。 促进产后母婴参与对于预防母婴进一步不良事件至关重要 为了实现积极的母婴参与，母亲需要学习有效的护理 NAS。 令人惊讶的是，目前针对高风险孕妇的产科实践标准。 妇女没有满足这一迫切需要，部分原因是没有干预措施来帮助未来的母亲做好准备 照顾有 NAS 风险的新生儿所面临的挑战 为了解决这一重大差距，我建议采用一项措施。 现有的移动 NAS 工具，用于临床医生培训和决策支持，针对高危孕妇并评估其 首先，我将进行小型随机对照模拟试验的可用性、可接受性和可行性。 对新生儿学专家、NAS 护理提供者和 NAS 受影响的母亲组成的小组进行结构化访谈 婴儿收集他们对 NAS 管理的建议并探讨他们对护理的看法 这些新生儿的研究结果将指导针对高危孕妇的现有移动 NAS 工具的调整。 然后我将通过对 10 名孕妇的调查来测试改编后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药物激动剂治疗 (OAT) 的女性 最后，我们将对在这些机构就诊的 30 名高危孕妇进行随机分组。 要么接受适应的移动 NAS 护理工具，要么接受常规护理，我们将比较这些母亲。 孕产妇药物复发和 OAT 继续、母婴关系、新生儿住院时间、 再入院率、母乳喂养开始和持续时间以及 4、8 和 12 岁时的产后抑郁和焦虑 产后几周的研究结果将作为后续大型 R01 随机对照模拟的试点数据。 试验测试改编后的 NAS 护理工具在减少 NAS 患者不良结局方面的功效 我提出的研究计划整合了活动、正式培训和指导。 来自专家（Sterling McPherson 博士、Hendree Jones、John Roll、Celestina Barbosa-Leiker 和 Kim Johnson） 在针对围产期妇女的物质使用障碍治疗的开发、测试和实施方面，移动 健康干预措施，对患有药物滥用障碍的围产期妇女进行临床试验。 指导研究科学家发展奖（K01）将建立在我之前的培训基础上，让我能够 追求我的长期职业目标，成为一名独立调查员，并制定既定计划 研究重点是围产期物质使用干预措施的开发、实施和测试 妇女和减少使用药物的围产期妇女及其新生儿的不良健康后果。