224 - Mom Is The Best Medicine For NOWS Neonate

Poster Number: 224
Publication Number: 224.127

Padmani Karna, Michigan State University College of Human Medicine, EAST LANSING, MI, United States; Lalitha Gundamraj, Michigan State University College of Human Medicine, Okemos, MI, United States; Amanda D'Alessandro, Sparrow Hospital, Lansing, MI, United States; Kathleen M. Wilson, Sparrow Hospital, Williamston, MI, United States; Miranda Stoneman, Sparrow Health System, Lansing, MI, United States; Jennifer Thompson-Wood, Sparrow Hospital, Lansing, MI, United States

Background:

Background: Optimal care of Neonatal Opioid Withdrawal syndrome (NOWS) neonates continue to be a national challenge. At our center during 2014-2020, nursing and medical teams were educated with components of key driver diagram, including standardized evaluation of withdrawal symptoms (Finnegan), NOWS care guidelines, and frequent regular feedback to all provides. All these efforts cumulatively decreased the duration of pharmacological treatment by 50% in 2020 from a Mean of 13 ± 8 days in 2018, however a portion of NOWS infants still needed medication for withdrawal.

Objective:

Objective: Our goal was to engage mother early for non-pharmacological care of NOWS infants and safely minimize pharmacological treatment to PRN use.

Design/Methods:

Design/Methods: Our next steps included focusing on educating mom shortly after birth with non-pharmacological strategies to decrease withdrawal symptoms and incorporation of ESC care model. Both, ESC and Finnegan scoring were done for initial 10 neonates to gain confidence and comfort with ESC model by nursing staff and providers. In addition, for mothers who lacked family support during hospitalization, the team developed support for mother during the daytime to get rest for 3 hours and obtain Methadone dose from clinic as needed.
Prior to this PDSA, we developed and educated all team members regarding Key Driver - Fig 1 for ESC care model and guideline for the care of NOWS infants listed in the Table 1.

Results:

Results: The QI team reviewed the overall care and the management of initial 10 NOWS infants after implementation. All NOWS were >35 wks gestation cared at the mother / baby unit. Seven babies were exposed to multiple substances, including Methadone or street drugs. Control chart - Fig 2 with duration of pharmacological treatment is presented. Only 1 of these NOWS neonate managed with ESC strategies needed PRN pharmacological treatment. Length of stay was 5.2 ± 1.7 days. Six babies were discharged with mother and the rest were discharged with foster family. None of these babies were readmitted in the hospital for NOWS symptoms within 4 weeks after discharge.Conclusion(s): Conclusion(s): Our results are consistent with published reports with significant decreased pharmacological treatment with ESC care model. We suggest, engaging and educating the mother of NOWS neonate shortly after birth with non-pharmacological care strategies is critical along with ESC care model. Providing additional support and care in hospital for NOWS mother is essential to minimize withdrawal in hospital and after discharge home.
Key Driver
Table 1