A collaborative program across units at Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt is changing the way nurses and doctors care for newborns diagnosed with drug withdrawal symptoms at birth, also known as neonatal abstinence syndrome (NAS).
The program, called Team Hope, is funded with a grant from the Memorial Foundation and support from VUMC and Children’s Hospital leadership. The interdisciplinary team is comprised of health care specialists from the Newborn Nursery, the Neonatal Intensive Care Unit and the acute care unit at Children’s Hospital along with Child Life, social workers and lactation consultants.
Their mission: to improve the care of the opioid-exposed mother-baby dyad through multifaceted, family-centered approach. The team seeks to keep mothers and babies together after birth and move them out of an intensive care setting when possible.
Previous Vanderbilt research revealed that standardizing hospital care policies across institutions for infants diagnosed with drug withdrawal symptoms at birth reduces their length of treatment and hospitalization. However, with many health care institutions caught off guard by the alarming and rapid rise in the number of infants born with NAS, the study showed that fewer than half of participating hospitals had policies to standardize care for affected infants.
In the United States, one infant is born every 15 minutes with withdrawal symptoms after being exposed to opioids before birth.
Team Hope has instituted evidence-based practices in the care of these infants to improve their outcomes, decrease length of stay and improve consistency of care for opioid-exposed infants.
“We have found that current models that exist to care for babies with drug withdrawal symptoms are not adequate. These infants get separated from their mom, are put in a noisy NICU with other crying infants, and that separation and environment makes withdrawal worse,” said Stephen Patrick MD, MPH, director of the Vanderbilt Center for Child Health Policy and assistant professor of Pediatrics and Health Policy in the Division of Neonatology with Children’s Hospital.
“We’ve changed that model of care. When these babies who are exposed to opioids have a long stay, they go to a general inpatient floor, unless they have other complications, and moms and babies can room together. We promote bonding and breastfeeding with a dedicated lactation consultant and Child Life specialist. We engage the family and coordinate volunteers on how to help the baby improve.”
Drug withdrawal symptoms can occur shortly after birth in infants exposed to opioids while in the womb.
Compared to other infants, those with drug withdrawal are more likely to experience respiratory complications and feeding difficulty, be born with low birth-weight and have longer lengths of stays in the hospital following birth.
“Team Hope was born out of a desire to provide better care not just for our infants affected by NAS, but for their families too,” said Travis Crook, MD, assistant professor of Pediatrics, Hospital Medicine and clinical lead for Team Hope.
“What makes Team Hope so special is the rare combination of passion, expertise and effort. The broad range of representation and expertise coupled with the desire to truly improve the care for these patients has created a culture change and brought about a community spirit to transforming Vanderbilt into a national center of excellence for NAS,” Crook said.
With Team Hope, the goal is to reduce those symptoms and complications with multidisciplinary support.
“In my experience caring for infants with opioid exposure, I have seen how important it is to have an engaged family. Team Hope offers additional support services for families that will lead to better outcomes for their babies,” said Anna Morad, MD, director of the Newborn Nursery.
For an infant and family to qualify for Team Hope intervention, the infant must be born at 35 weeks or later, have been exposed to opioids in utero and not have another medical condition, like breathing difficulty, which would lead to a NICU admission. Early data collection since Team HOPE launched in fall 2017 proves to be promising, with more than 100 newborns meeting the eligibility criteria, and only 17 percent requiring treatment with morphine for NAS.
For all Team Hope infants, the average length of stay was five days, while infants diagnosed with NAS had an average length of stay of 12 days. While readmission after discharge is not uncommon for NAS infants, none of the Team Hope infants were readmitted within seven days post-discharge.
Other Team HOPE members include Erin Munn, MS, CCLS, Child Life specialist; Michelle McPherson, RN, lactation consultant, and Mary White, MPH, program manager. But the team extends well beyond the core group, and includes a diverse cross-section of disciplines, backgrounds as nurses, physicians, child welfare workers and beyond.
They meet every two weeks for case conferences, to analyze their standards of care and ensure consistency in care, as well as to identify evidence-based practices that have been particularly effective in their care model.