Fund NICUs to provide care for infants with NAS
Recommendation
Congress should utilize tax credits and grant programs to fund new (or existing) newborn intensive care units in all hospitals to provide specialized care for infants with neonatal abstinence syndrome (NAS) and ensure mothers and their children remain in close proximity with each other after birth.[1]
Background/summary
Neonatal abstinence syndrome (NAS) is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth.[2][3] Approximately 7 percent of women self-report using prescription opioid pain relievers while pregnant; of those, one in five report misuse of prescription opioids.[4][5] Six newborns are diagnosed with NAS for every 1,000 newborn hospital stays, equivalent to one baby diagnosed with NAS every 24 minutes or more than 59 newborns diagnosed every day.[4][6][7] The number of babies born with NAS increased by 117 percent nationally from 2009 to 2020.[6]
Recent studies found that newborns diagnosed with NAS who stay with their mothers after delivery, (i.e., “room-in,”) have better outcomes than those who go to the neonatal intensive care unit (NICU).[8][9][10] Babies with NAS who room-in with their mothers are far less likely to need pharmacological interventions and leave the hospital days sooner than those who remain in the NICU.[8][9][10] Rooming-in and other non-pharmacologic interventions, such as creating a low-stimulation environment, swaddling, and feeding on demand, should be the evidence-based standard of care for newborns with NAS.[1][8][9][10][11][12]
Hospitals may not have the infrastructure to keep mothers and babies in the same room.[13] Therefore, incentives are needed – including tax credits and grant programs – to fund new and existing efforts within the NICU so mothers and infants with NAS remain together immediately following birth.[1]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Accessed October 2017.
2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. About Opioid Use During Pregnancy. Last Accessed March 21, 2023.
3. March of Dimes. Neonatal Abstinence Syndrome (NAS). Last Reviewed: June 2019. Retrieved July 5, 2023.
4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Data and Statistics About Opioid Use During Pregnancy. Last Accessed March 21, 2023.
5. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy – U.S. Jurisdictions, 2019. Last Accessed July 17, 2020.
6. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) Fast Stats – Neonatal Abstinence Syndrome (NAS), National and State. Last Accessed July 5, 2023.
7. Ashley H. Hirai, Jean Y. Ko, Pamela L. Owens, Carol Stocks, Stephen W. Patrick. Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. Journal of American Medical Association. Last Accessed January 12, 2021.
8. Alexander Otto. Study: Don’t separate NAS infants from moms. Society of Hospital Medicine, The Hospitalist. Last Accessed September 7, 2017
9. Kathryn Dee L. MacMillan, Cassandra P. Rendon, Kanak Verma, Natalie Riblet, David B. Washer, Alison Volpe Holmes. Association of Rooming-in with Outcomes for Neonatal Abstinence Syndrome. American Medical Association, JAMA Pediatrics. Last Accessed April 2018.
10. Alison Volpe Holmes, Emily C. Atwood, Bonny Whalen, Johanna Beliveau, J. Dean Jarvis, John C. Matulis, Shawn L. Ralston. Rooming-in to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. American Academy of Pediatrics, Pediatrics. Last Accessed June 1, 2016.
11. Roschanak Mossabeb and Kevin Sowti. Neonatal Abstinence Syndrome: A Call for Mother-Infant Dyad Treatment Approach. American Academy of Family Physicians, American Family Physician. Last Accessed September 2021.
12. Matthew R. Grossman, MD; Matthew J. Lipshaw, MD; Rachel R. Osborn, MD; Adam K. Berkwitt. A Novel Approach to Assessing Infants with Neonatal Abstinence Syndrome. American Academy of Pediatrics, Hospital Pediatrics. Last Accessed January 1, 2018.
13. National Institute for Children’s Health Quality. A Mother-Centered Approach to Treating Neonatal Abstinence Syndrome. Last Accessed July 5, 2023.