Winning Poster: An evaluation of a novel pediatric transitional care facility for neonatal abstinence syndrome care

Abstract

Rising rates of Opioid use during pregnancy are creating new challenges in treatment of perinatal women with substance use disorders and their infants experiencing substance withdrawal symptoms (Neonatal Abstinence Syndrome [NAS]). System-level challenges, including fragmented healthcare systems and limited access to comprehensive perinatal care highlight significant gaps in neonatal care amidst rising Opioid use. Pediatric transitional nurseries are a relatively recent development in the United States, designed to offer comprehensive care for infants exposed to substances in utero by emphasizing non-pharmacological interventions centered on the maternal-infant dyad. However, there is currently a lack of research that assesses the outcomes of infants utilizing these facilities. Objective: The aim of this study was to determine the health outcomes of infants with in-utero substance exposure utilizing services of a pediatric transitional care facility across an 18-month period in Washington state. Methods: The pediatric transitional care facility provided descriptive data for 71 infants and birthing parents utilizing its services between 2023 and 2024. The Hopkin's Tool (Velez et al., 2021) was used to assess the progress of the infants throughout their stay at the facility at three time points (Admit, Midpoint, and Most Recent/Discharge). This assessment monitors four systems (Autonomic Nervous System, Motor/Muscle Tone, State Control/Attention, Sensory Reactivity) via a three-category scale: Impaired; Mild Dysfunction; Optimal. A one-way analysis of variance (ANOVA) was used to assess potential change in each individual systems' mean Hopkin's Tool score over time and, when appropriate, a post-hoc Tukey test was used to identify significant changes. Infant demographic and medical data, as well as birthing parent data were also collected and are described using means, standard deviations, and percentages. Results: On average, infants were exposed to 3.7 different substances (standard deviation [SD]: 1.6) The most common substance exposure was to methamphetamines (n = 57; 81.4 %) followed by fentanyl (n = 52; 74.3 %), tobacco (n = 38; 53.5 %), methadone (n = 30; 42.3 %), marijuana (n = 22; 31.4 %), and other unspecified opioids (n = 17; 24.3 %). Sixty infants that had been discharged back into the community had data on their length of stay at Maddie's Place. The average length of stay of those infants that had been discharged was 56 days (SD: 31.9). Information on birthing parents was provided for 63 infants. The largest group, 34 infants (54 %), went into the community with their birthing parent, and an additional 9 (14 %) went with a relative. There were 17 infants (23.9 %) released with a foster and two (2.8 %) with foster-relatives. One (1.6 %) infant reportedly left with a “suitable other”. Infants receiving care at the Spokane-based pediatric transitional care facility showed statistically significant improvement in assessments monitoring all four developmental systems via the Hopkins Tool (p < .05). Implications: Novel pediatric care facilities may offer a low-intervention, nurturing care model that aims to improve infant outcomes and reduce healthcare costs. This study is the first to describe the impact of such a pediatric transitional care facility in the US.