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Objectives. To estimate use of medication for opioid use disorder (MOUD) and prescription opioids in pregnancy among mothers of infants with neonatal opioid withdrawal syndrome (NOWS). Methods. We used linked 2016–2018 North Carolina birth certificate and newborn and maternal Medicaid claims data to identify infants with an NOWS diagnosis and maternal claims for MOUD and prescription opioids in pregnancy (n = 3395). Results. Among mothers of infants with NOWS, 38.6% had a claim for MOUD only, 14.3% had a claim for prescription opioids only, 8.1% had a claim for both MOUD and prescription opioids, and 39.1% did not have a claim for MOUD or prescription opioids in pregnancy. Non-Hispanic Black women were less likely to have a claim for MOUD than non-Hispanic White women. The percentage of infants born full term and normal birth weight was highest among women with MOUD or both MOUD and prescription opioid claims. Conclusions. In the 2016–2018 NC Medicaid population, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be a result of medically appropriate opioid use in pregnancy.

The world has been experiencing an opioid epidemic for over 20 years, and rates of use and overdose among women, including during pregnancy, have risen markedly. Women receive more prescriptions for opioids compared to men. Data suggest that 20% of women filled at least one prescription for an opioid during their pregnancy, and the prevalence of prenatal exposure averaged 14%. Opioid use by women, especially during pregnancy and while breastfeeding, and management and treatment is complex for healthcare providers, especially related to methadone treatment, pain management during labour, neonatal opioid withdrawal syndrome, nutritional issues and maternal withdrawal. Opioid use during pregnancy has been associated with maternal, foetal and infant complications, and overdose has become a leading cause of death in post-partum women in some countries. Universal screening for opioid use disorder (OUD) is recommended in pregnancy, and prevention and treatment programs that meet the specific needs of women are important to understand and consider as the world continues to try to anticipate and respond to the realities of the opioid epidemic.

Neonatal abstinence syndrome (NAS) is a significant public health problem in the United States. The most commonly used tool to assess and treat infants with NAS is the Finnegan Neonatal Abstinence Scoring System (FNASS). The more recently developed Eat, Sleep, Console (ESC) method simplifies assessment of NAS. Current research suggests promising outcomes with the ESC method in areas such as length of hospital stay (LOS) and amount of medication needed to treat NAS. A literature review was conducted to answer the following question: In newborn infants with NAS born at 36 weeks of gestation or older, does the ESC method reduce the use of medication and LOS when compared with the FNASS? All of the studies reporting on LOS and medication usage rates reported a decrease in both when moving to the ESC method from FNASS.

OBJECTIVES: The number of women with opioid-related diagnoses in the United States has significantly increased in recent decades, resulting in concomitantly higher rates of infants born with neonatal opioid withdrawal syndrome (NOWS). Addressing prenatal opioid exposure is a priority for Alaska health systems. The objectives of this study were to: 1) identify maternal and neonatal factors associated with receipt of Medication for opioid use disorder (MOUD) and 2) determine the impact of prenatal MOUD on discharge to parents among infants with NOWS in three Alaska hospitals. METHODS: A retrospective chart review using a standard abstraction form was conducted to collect data on neonatal and maternal characteristics, neonatal treatment, and infant discharge disposition for infants with NOWS born at the three hospitals between July 2016 and December 2019. A multivariable logistic regression model was used to determine factors associated with discharge to parents. RESULTS: There were 10,719 births at the three hospitals during the study period, including 193 infants (1.8%) with NOWS. Among the 193 mothers, 91 (47.2%) received MOUD during pregnancy. Among infants with NOWS, 136 (70.5%) were discharged to parents, 51 (26.4%) were discharged to a relative or foster care. Infants were significantly (OR 3.9) more likely to be discharged to parents if the mother had received prenatal MOUD. CONCLUSIONS: MOUD among pregnant women with opioid use disorder furthers the goal of keeping families together and is a critical step towards reducing the impact of the ongoing opioid epidemic on Alaska families, communities, and the child welfare system.

BACKGROUND: Infants with in-utero exposure to opioids are at risk Neonatal Opioid Withdrawal Syndrome (NOWS) and non-pharmacological methods of care, like swaddling, quiet ambient environment are routinely recommended but are not systematically studied. We hypothesized that opioid exposed infants can tolerate whole body massage while hospitalized. METHODS: This is a prospective observational study (August 2017 to January 2019) and infants of mothers having a history of opioids use (OUD) were included. Infants received whole body massage for 30 minutes from birth till discharge home. Infants heart rate (HR), respiratory rate (RR), systolic (sBP) and diastolic blood pressure (dBP) were recorded prior to and at the end of massage session. RESULTS: The pilot study enrolled 30 infants. The mean birth weight and gestational age were 38±1 weeks and 2868±523 grams, respectively. All massage sessions were well tolerated. There was marked decrease in HR, systolic and diastolic BP and RR, (p

To assess whether a shorter length of stay (LOS) is associated with a higher risk of readmission among newborns with neonatal abstinence syndrome (NAS) and examine the risk, causes, and characteristics associated with readmissions among newborns with NAS, using a longitudinally linked population-based database.Our study sample included full-term singletons with NAS (n = 4,547) and without NAS (n = 327,836), born in Massachusetts during 2011-2017. We used log-binomial regression models to estimate the crude risk ratios (cRRs) and adjusted RRs with 95% confidence intervals (CI) of the association between LOS and readmissions, controlling for maternal age, race/ethnicity, education, marital status, insurance, method of delivery, birthweight, adequacy of prenatal care, smoking, and abnormal conditions of newborn.Compared with infants without NAS, infants with NAS had a non-significantly higher risk of readmission within 2-42 days (2.8% vs. 2.5%; p = 0.17) and a significantly higher risk of readmission within 43-182 days (2.7% vs. 1.8%; p 0.001). The risk of readmission within 2-42 days was significantly higher among infants with NAS with a LOS of 0-6 days compared to a LOS of 14-20 days (reference group) (aRR: 2.1; 95% CI: 1.2-3.5). No significant differences in readmission rates between 43 and 182 days were observed across LOS categories.Among infants with NAS, a LOS of 0-6 days was associated with a significantly higher risk of readmission within 2-42 days of discharge compared to a longer LOS.

BACKGROUND: Previous research indicated that diabetes during pregnancy results in a more permeable placenta. Based on this data, we hypothesized that women with maternal diabetes were more likely to have infants who developed neonatal abstinence syndrome (NAS). PURPOSE: The purpose of the study was to examine the association between maternal diabetes and NAS in a cohort of women reporting substance use during pregnancy. METHODS: This study used data from a population-based cohort of all newborns born in 2017 and 2018 (N = 36,974) in the state of West Virginia and restricted the analysis to those infants with intrauterine substance exposure (14%, n = 5188). Multiple logistic regression was performed to analyze the adjusted relationship between maternal diabetes and NAS while controlling for maternal and infant covariates. RESULTS: Just over 28% of women with diabetes had an infant who developed NAS, whereas 34.8% of women without diabetes had an infant who developed NAS. The adjusted odds ratio of infants developing NAS born to women with diabetes was 0.70 (95% confidence interval: 0.51, 0.94) compared with those born to mothers without diabetes after controlling for covariates. Contrary to our hypothesis, the study suggests that maternal diabetes during pregnancy is associated with a decreased risk of an infant developing NAS. IMPLICATIONS FOR PRACTICE: Future research generating from this hypothesis may lead to potential implications for practice for infants born to mothers with substance use during pregnancy and diabetes. IMPLICATIONS FOR RESEARCH: More research should be conducted to investigate the relationship between glucose metabolism and NAS.

RESUMEN Introducción: la adicción a sustancias ilícitas constituye un problema de salud pública, del cual no están exentas las embarazadas. Los efectos deletéreos sobre el feto pueden tener consecuencias catastróficas. Objetivo: Determinar la frecuencia de uso de drogas ilícitas en mujeres gestantes y caracterizar a estas mujeres y sus recién nacidos de julio de 2020 a julio de 2021. Material y método: Estudio transversal, descriptivo, observacional con madres con sospecha de uso de drogas y sus recién nacidos (RN). Se buscó asociación entre variables estudiadas. Se utilizó escala de Finnegan para síndrome de abstinencia neonatal (SAN) y se determinó presencia de drogas en orina. Resultados: Fueron incluidos 107 binomios madres -hijos. Prevalencia de madres adictas de 11,42%. Edad promedio de madres 24,5 años y 29,9% en situación calle. 70% fueron partos vaginales, 90,5% con APGAR de 7-10. 26,1% fueron RN prematuros. RCIU 34,5%, PEG 35,5%. 93,3% mujeres se autorreportó como consumidora, 57,9% tuvo control prenatal nulo. 56% de gestantes presentó signos evidentes de ser consumidora de drogas ilícitas al ingreso. La droga más consumida fue la cocaína (COC) 85%. Detección de cocaína en RN fue 81,3%. SAN en 24,2% RN. Se encontró Cocaína en la orina de 18/26 de los pacientes con SAN, y en 64/77 de los pacientes sin síndrome de abstinencia. Tuvo Lues el 25,9%. Se encontró asociación de SAN con la presencia de COC en el RN. Conclusiones: el consumo de drogas en la embarazada expone al RN a drogas deletéreas, siendo la droga más frecuentemente consumida la COC. La prevalencia de SAN fue baja, encontrándose asociación entre esta entidad y la presencia de COC en RN. ABSTRACT Introduction: Addiction to illicit substances constitutes a public health problem, from which pregnant women are not exempt. The deleterious effects on the fetus can have catastrophic consequences. Objective: To determine the frequency of illicit drug use in pregnant women and to characterize these women and their newborns during the time period from July 2020 to July 2021. Materials and methods: this was a cross-sectional, descriptive, observational study with mothers suspected of drug use and their newborns (NBs). An association was sought between the studied variables. The Finnegan scale for neonatal abstinence syndrome (NAS) was used and the presence of drugs in urine was determined. Results: 107 mother-child pairs were included. The prevalence of addicted mothers was 11.42%. Average age of mothers was 24.5 years and 29.9% were living on the street. 70% were vaginal deliveries, 90.5% with an APGAR score of 7-10. 26.1% were premature newborns. IUGR 34.5%, SGA 35.5%. 93.3% women self-reported as drug consumers, 57.9% had zero prenatal control. 56% of pregnant women presented obvious signs of being an illicit drug user upon admission. The most consumed drug was cocaine (COC), 85%. Detection of cocaine in newborns was 81.3%. NAS was diagnosed in 24.2% NB. Cocaine was found in the urine of 18/26 of the patients with NAS, and in 64/77 of the patients without withdrawal syndrome. 25.9% had Lues. An association of NAS with the presence of COC in the newborn was found. Conclusions: drug use in pregnant women exposes the newborn to deleterious drugs, COC being the most frequently used drug. The prevalence of NAS was low, although we found an association between NAS and the presence of COC in newborns.

To compare prenatal exposures, hospital care processes, and hospitalization outcomes for opioid-exposed newborns before and during the coronavirus disease 2019 (COVID-19) pandemic.In this multicenter retrospective analysis, data were collected from 19 Massachusetts hospitals, including 5 academic and 14 community hospitals. The pre-COVID-19 cohort was defined as births occurring during March 1, 2019-February 28, 2020, and the COVID-19 cohort was defined as births occurring during March 1, 2020-December 31, 2020. Opioid-exposed newborns born at ≥35 weeks of gestation were included. Differences in prenatal substance exposures, hospital care processes, and neonatal opioid withdrawal syndrome (NOWS) outcomes, including pharmacologic treatment for NOWS (PharmTx), length of stay (LOS), and as-needed (prn) treatment failure rates, were evaluated.There were 663 opioid-exposed newborns in the pre-COVID-19 group and 476 in the COVID-19 group. No between-group differences were seen in prenatal substance exposures or the need for PharmTx. Compared with the pre-COVID-19 group, in the COVID-19 group there was less rooming-in after maternal discharge (53.8% vs 63.0%; P = .001) and less care in the pediatric unit setting (23.5% vs 25.3%; P = .001), longer LOS (adjusted risk ratio, 1.04; 95% CI, 1.01-1.08), and a higher rate of breast milk receipt at discharge (aOR, 2.03; 95% CI, 1.22-3.39). Within the subset of academic centers, more infants failed prn treatment in the COVID-19 group (53.8% vs 26.5%, P = .02; aOR, 3.77; 95% CI, 0.98-14.5).Among the hospitals in our collaborative, hospital processes for NOWS, including care setting, rooming-in, and LOS were negatively impacted in the COVID-19 group, particularly in academic medical centers.

America's opioid epidemic has spawned an epidemic of neonatal abstinence syndrome (NAS). Studies have not tested approaches to promoting contraceptive services for women with opioid use disorder (OUD) along with treatment for this disorder. This pilot study examined the promotion of medication for OUD (MOUD) treatment and contraception use, primarily long-acting reversible contraception (LARC), for women with OUD.In Appalachia, a peer-delivered contraception and MOUD promotion intervention was delivered to a sample of 30 women with OUD. Primary outcomes were attendance of initial appointments to receive MOUD and counseling about contraceptive options. Peer recovery coaches also offered to help the women schedule appointments and attend the appointment with them or give them a ride if necessary and requested by the patients.Two-thirds experienced all seven symptoms of opioid dependence. Within 30 days of a brief counseling session, over one-half of the women (56.7%) were referred to MOUD, with all of them initiating treatment within 30 days. Just under one-half of the women (46.7%) were referred to a contraception consultation, with 85.7% of those receiving a LARC implant.Study findings indicate the potential efficacy of a single-session, peer-delivered counseling intervention for linking women with OUD and at high risk of unintended pregnancy to MOUD and to services that provide women with highly reliable contraceptives.This study is unique in exploring the efficacy of linking high-risk opioid-using women to contraceptive options and treatment for MOUD to prevent NAS.

This study aimed to determine the effect of a prenatal education program for opioid-dependent women on breastfeeding frequency, newborn hospital length of stay, and cost of care for neonates at risk of developing neonatal abstinence syndrome.From January 1, 2015 to January 1, 2020, opioid-dependent obstetric patients were educated on non-pharmacological preventative measures for neonatal abstinence syndrome (NAS), with focused counseling on breastfeeding. Data were collected and compared to a control group of opioid-dependent pregnant women who received standard care before initiation of the education program.Sample size calculation revealed that to detect doubling of the breastfeeding rate from 25% to 50% with 80% power and α error of 0.05, 66 participants were required in each group.There were 75 women with opioid use disorder who had prenatal NAS education (study group) and 108 women with opioid use disorder who underwent standard care before NAS education (control group). Prenatal NAS education participants significantly increased breastfeeding initiation rates compared to the control group. Newborn length of stay significantly decreased after initiation of prenatal NAS education compared to the 36 months before NAS education program.

The Boarder Program is a unique, family-centered program designed to keep a mother and her infant together when the mother has been discharged, but her infant requires additional medical attention and hospitalization. The hospital-sponsored program includes a room in the obstetric department, meals, and services. This provides the mother and second caregiver the opportunity to participate in their infant’s physical care and engage in the decision-making process. The program is designed to support families with infants in an intermediate care nursery and has been expanded to include infants experiencing neonatal abstinence syndrome (NAS). The purpose of this article is to describe the Boarder Program at a community medical center, share its history, and provide evidence-based support for the effectiveness of this model.

Brojni povijesni zapisi i dokazi ukazuju na to da korištenje droga nije fenomen novijeg razdoblja. Razvoj medicine utjecao je na shvaćanje učinaka droge na organizam, definirana je fizička i psihička ovisnost, tolerancija i apstinencijski sindrom. Sukladno sve većim zanimanjem stručnjaka za područje ovisnosti, nude se brojne definicije pojmova ovisnosti i psihoaktivne tvari. Iz ponuđenog je jasno vidljivo kako je u svim definicijama ovisnosti opisana žudnja za konzumacijom psihoaktivne tvari, dok je svim definicijama psihoaktivnih tvari zajednička činjenica kako se radi o tvarima prirodnog ili sintetiziranog porijekla, s moći izazivanja promjena psihičkog i/ili fizičkog stanja. Osim što se psihoaktivne tvari mogu podijeliti na prirodne i kemijski stvorene (podjela prema porijeklu), postoji podjela prema načinu djelovanja na središnji živčani sustav, pa se dijele na psihodepresorne, psihostimulativne i halucinogene droge. Konzumacijom psihoaktivnih sredstava, neovisno o tome kojoj skupini pripadaju, javljaju se mnogi štetni učinci i posljedice. Oni prvenstveno uzrokuju zdravstvene probleme, no uz njih se javljaju i društveni te socioekonomski problemi. Rastom incidencije o zlouporabi droga, raste i mogućnost sve većeg broja trudnoća koje su ugrožene zbog prenatalnog djelovanja teratogenog agensa na nerođeno dijete. Pri konzumaciji sredstvo prolazi kroz placentu, ulazi u djetetov krvotok i uzrokuje razne probleme. Neonatalni apstinencijski sindrom klinička je dijagnoza koja se javlja kod novorođenčadi majki ovisnica, a javljaju se simptomi gastrointestinalnog, respiratornog i središnjeg živčanog sustava, te poremećaji vazomotorike i promjene na koži, najčešće u prvih 48 sati života. Manifestacija simptoma ovisi o koncentraciji opijata u majčinu krvotoku. U skrbi za dijete sudjeluju specijalisti nekoliko područja, a sve u svrhu rješavanja kompleksnih specifičnih problema i osiguranja adekvatne skrbi za dijete. U tretmanu se roditelje nastoji uključiti u što više aktivnosti, s obzirom na to da se i samim kontaktom i prisutnošću mogu ublažiti simptomi neonatalnog apstinencijskog sindroma. Medicinske sestre moraju vladati širokim stručnim znanjem, vještinama, komunikacijom, a profesionalnim odnosom i iskazivanjem empatije, postiže se bolja suradnja roditelja, što uvelike pridonosi bržem oporavku., Numerous historical records and evidence suggest that drug use is not a phenomenon solely of recent times. The development of medicine influenced the understanding of the effects of drugs on the body, the physical and psychological dependence was defined, alongside the concepts of tolerance and the withdrawal syndrome. The growing interest of experts in the field of addiction is followed with an inflow of new proposals of numerous definitions for both addiction and psychoactive substances. From the current state, it is clear that in all definitions present, addiction is described as a craving for consumption of psychoactive substances, while all the definitions of psychoactive substances understand ingredients of natural or synthetic origin, with the ability to cause changes in mental and/or physical condition. In addition to the division of psychoactive substances to natural and chemically created (classification by origin), there is a classification according to the effect of the substances on the central nervous system, which goes as follows: psychodepressors, psychostimulants and hallucinogens. Consumption of psychoactive substances, regardless of which group they belong to, is a direct cause to various side effects. Primarily, they cause health problems, but these are often followed with social and socio-economic problems. Growing incidence of drug abuse increases the possibility of highly volatile pregnancies due to the prenatal effects of teratogenic agents on the unborn child. When using, the substance passes through the placenta, into the child’s blood stream causing various problems. A neonatal abstinence syndrome is a clinical diagnosis in infants of addicted mothers, and is manifested as the underdevelopment of gastrointestinal, respiratory and central nervous system, as well as the vasomotoric disorders and changes on the skin, usually in the first 48 hours of life. The manifestation of symptoms depends on the concentration of opiates in the mother's bloodstream. In child care, the specialists involved come from a wide range of areas, all with the combined aim to solve complex problems and ensure adequate care for the child. The treatment aims to involve parents in as many activities under the mentioned care due to the possible positive effects of contact and presence of a parent on the child suffering from the neonatal abstinence syndrome. Nurses must possess a wide set of skills, high expertise and professional attitude and through empathy they can achieve cooperation and a better understanding with parents, which can directly aid the process of recovery.

Einleitung: Das neonatale Abstinenzsyndrom (NAS) stellt eine große Leidenslast für die Familien sowie eine Belastung für das Gesundheitssystem dar. Übliche Symptome der Neugeborenen sind Zittern, Krampfanfälle und Ernährungsprobleme. Zudem sind Neugeborene übererregbar und reagieren verstärkt auf Umgebungsreize. Die nicht-pharmakologischen Interventionen sind besonders wichtig, um die bestmöglichsten kognitiven, motorischen und sprachlichen Ergebnisse zu erzielen. Diese Bachelorarbeit ging daher der Frage nach, welche pflegerischen Interventionen für die Symptomminimierung bei NAS effektiv sind und wie das Pflegepersonal die Mütter in dieser Situation am besten unterstützen und beraten kann. Methodik: Diese Bachelorarbeit beruht auf einer systematischen Literaturrecherche in den Datenbanken PubMed und CINAHL sowie der Maternity & Infant Care Database. Wissenschaftliche Quellen wurden aus diesen Datenbanken unter Rücksichtnahme der beschriebenen Ein- und Ausschlusskriterien für die Bearbeitung dieser Arbeit herangezogen. Die ausgewählten Studien wurden inhaltlich und formal auf ihre Qualität geprüft. Ergebnisse: Stillen und Rooming-In können als zwei wichtige nicht-pharmakologische Interventionen zur Linderung von einem neonatalen Abstinenzsyndrom angesehen werden und sollten in die Standard-Pflege eines Neugeborenen mit neonatalem Abstinenzsyndrom einbezogen werden. Bedingt durch den Mangel an Informationen und Wissen sowie Vorurteilen und Voreingenommenheit des Pflegepersonals kommt es dazu, dass die Bereitschaft der Mütter, an der Pflege teilzuhaben, sinkt. Daher ist es besonders wichtig, dass Pflegepersonen ausreichend Information und Ausbildung für das neonatale Abstinenzsyndrom erhalten, um dieses dann an die Mütter weitergeben zu können. Ebenfalls wichtig ist die emotionale Unterstützung der Mütter durch die Pflegepersonen. Schlussfolgerung: Stillen und Rooming-In sind zwei Interventionen, die den Verlauf des neonatalen Abstinenzsyndroms bei Neugeborenen mindern, und müssen daher in die Standard-NAS-Pflege integriert werden. Barrieren in der Pflege wie mangelndes Wissen und Informationen sowie die emotionale Unterstützung der Mütter sollen durch das Pflegepersonal behoben werden, um die bestmöglichste Pflege für das Neugeborene zu schaffen. Schlüsselbegriffe: Neonatales Abstinenzsyndrom, neonatales Opioidentzugssyndrom, nicht-pharmakologische Interventionen, nicht-medikamentöse Maßnahmen, Mütter, Beratung, Neugeborene Introduction: Neonatal abstinence syndrome (NAS) places a great burden on families and the health care system. Common symptoms in the newborn include tremors, seizures, and feeding problems. In addition, newborns are overstimulated and react more strongly to environmental stimuli. The non-pharmacological interventions are particularly important to achieve the best possible cognitive, motor and language outcomes. Therefore, this bachelor thesis addressed the question of which nursing interventions are effective for minimizing symptoms of NAS and how nursing staff can best support and advise mothers in this situation. Methodology: This bachelor thesis is based on a systematic literature search in the databases PubMed and CINAHL as well as the Maternity & Infant Care Database. Scientific sources were used from these databases, taking into account the inclusion and exclusion criteria described, for the processing of this work. The selected studies were checked for their quality in terms of content and form. Results: Breastfeeding and rooming-in can be considered as two important non-pharmacological interventions to alleviate neonatal abstinence syndrome and should be included in the standard care of a neonate with neonatal abstinence syndrome. Due to the lack of information and knowledge, as well as prejudices and biases of nurses, mothers' willingness to participate in their care decreases. Therefore, it is especially important that nurses receive sufficient information and education for neonatal abstinence syndrome so that they can then pass it on to mothers. Also important is the emotional support that caregivers provide to mothers. Conclusio: Breastfeeding and rooming-in are two interventions that mitigate the progression of neonatal abstinence syndrome in newborns and therefore need to be integrated into standard NAS care. Barriers to care such as lack of knowledge and information and emotional support for mothers should be addressed by nurses to create the best possible care for the newborn. Keywords: Neonatal abstinence syndrome, neonatal opioid withdrawal syndrome, non-pharmacologic interventions, nursing interventions, mothers, counselling, newborns

Einleitung: Das neonatale Abstinenzsyndrom (NAS) ist eine Krankheit, die bei Neugeborenen entstehen kann, wenn diese in der Gebärmutter Drogen ausge-setzt waren. Legale und illegale Drogen haben eine negative Auswirkung auf den Embryo, die sich im schlimmsten Fall auf sein ganzes Leben auswirken können. Dabei erscheinen bei den Neugeborenen Symptome wie Hyperaktivität, ein gestörtes Schlafmuster, schrilles Schreien, Tremor, Krampfanfälle, Erbre-chen, Diarrhöe, Atemstörungen, Gewichtsverlust und die Unfähigkeit Gewicht zuzulegen. Methodik: Für die Literaturrecherche wurden die Datenbanken „CINAHL“, „Pub-Med“, „OVID“ und „Academic Search“ verwendet. Mit bestimmten Suchbegriffen und den Boole‘schen Operatoren „AND“, „OR“ wurde nach passenden Literatu-ren gesucht. Für diese Bachelorarbeit wurden insgesamt zwölf Studien herange-zogen. Ergebnisse: Aus den Ergebnissen der Studie kann festgestellt werden, dass nicht pharmakologische Interventionen wie das Rooming-in, KMC, Wickeln, be-stimmte Positionierungen etc. sehr wirksame Methoden sind, die für die Behand-lung von NAS eingesetzt werden können. Rooming-in ist mit einem verkürzten Krankenhausaufenthalt, einer kürzer Behandlungsdauer und einem geringeren Bedarf an medikamentöse Therapie verbunden. Ebenso konnte festgestellt wer-den, dass Rooming-in die Stillrate erhöht. Aus den Ergebnissen geht hervor, dass Säuglinge mit NAS, deren Mütter in einem Substitutionsprogramm sind, ge-stillt werden können und dies sogar empfehlenswert ist. Schlussfolgerung: Pflegerische Interventionen wie zum Beispiel das Rooming-In sind effektive und kostengünstige Methoden, um die Lebensqualität der kran-ken Säuglinge zu steigern. Entgegen der allgemeinen Meinung ist es empfeh-lenswert, Neugeborene mit NAS zu stillen. Auch Mütter in Substitutionsprogram-men gilt es zu ermutigen, ihre Kinder zu stillen, da dies nur Vorteile für Mutter und Kind mit sich bringt. Introduction: Neonatal abstinence syndrome (NAS) is a condition that can de-velop in newborns when they have been exposed to drugs in utero. Legal and illegal drugs have a negative effect on the embryo, which can in the worst case affect it`s whole life. The newborns have symptoms such as hyperactivity, dis-turbed sleep pattern, shrill crying, tremor, seizures, vomiting, diarrhea, breathing disorders, weight loss and inability to gain weight. Methodology: The databases "CINAHL", "PubMed", "OVID" and "Academic Search" were used for the literature search. Specific search terms and Boolean operators "AND", "OR" were used to search for matching literatures. A total of twelve studies were used for this bachelor thesis. Results: From the results of the study, it can be concluded that non-pharmacological interventions such as rooming-in, KMC, swaddling, positioning, etc. are very effective methods that can be used for the treatment of NAS. Room-ing-in is associated with a shorter hospital stay, shorter duration of treatment, and less need for drug therapy. Similarly, rooming-in was found to increase breast-feeding rates. The results indicate that infants with NAS whose mothers are in a substitution program can be breastfed. Conclusion: Nursing interventions such as rooming-in are effective and inex-pensive methods of improving the quality of life of sick infants with NAS. Against common sense it can be only recommended to breastfeed the new-born. Mothers in substitution programs should be encouraged to breastfeed, as it only brings benefits for the child and the mother.

Background Infants with neonatal abstinence syndrome (NAS) are at an increased risk for diaper dermatitis, which can cause skin breakdown and lead to significant pain and potential infection exposure. Skin care protocols in the neonatal intensive care unit (NICU) setting seldom specifically address the needs of this at-risk population, leading to inconsistent skin care management. Purpose The goal was to support a decrease in the rate of diaper dermatitis for infants with NAS by designing and implementing an evidence-based skin care protocol. Methods A retrospective medical record review was used to examine outcomes of 25 infants preintervention and 8 infants postintervention. The skin care protocol was a bundle of 5 evidence-based interventions: (1) a specific diaper dermatitis assessment tool; (2) frequent diaper changes with superabsorbent diapers; (3) application of petroleum jelly and alcohol-free wipes; (4) infant bathing in pH neutral soap; and (5) application of zinc oxide barrier cream for erythema. Results There was an overall 80.5% decrease in diaper dermatitis from pre- to postimplementation (P ≤ .01) as noted when comparing positive cases of diaper dermatitis with negative cases from pre- to postintervention. Implications for practice Expanding the skin care protocol to all neonates in the NICU and nursery could aid in maintaining skin integrity and decreasing diaper dermatitis in the NICU. More research is needed following this study for the data to be generalizable to other NICUs. This study offers key takeaways including using a specific diaper dermatitis assessment tool and consistently using the bundle of interventions.Video Abstract Available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=47.

Opioid use disorder (OUD) poses a significant public health concern impacting maternal and infant outcomes. In 2018, the Centers for Disease Control and Prevention (CDC) partnered with the Association of State and Territorial Health Officials (ASTHO) to develop the Opioid use disorder, Maternal outcomes, and Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) to identify and disseminate best practices and strategies for implementing systems-level changes in state health departments to address OUD affecting pregnant and postpartum persons and infants prenatally exposed to opioids. In 2019, the OMNI LC incorporated a field placement approach that assigned temporary field placement staff in five select OMNI LC states to provide important linkages, facilitate information sharing, and strengthen capacity among state and local health departments and other partners supporting maternal and child health communities affected by the opioid crisis. Using an implementation science framework, the field placement approach was assessed using five implementation outcome measures: appropriateness, acceptability, implementation cost, sustainability, and feasibility. Written responses from the participating OMNI LC states on these implementation outcome measures were analyzed to (1) highlight key strategies used by field placement staff, (2) assess the implementation of the OMNI LC field placement approach within the context of implementation science, and (3) identify implementation barriers. This report describes the implementation of a temporary field placement approach and suggests that this approach could be replicated to enhance state and local capacity to respond to the opioid crisis or other high-consequence events.

Opioid use disorder (OUD) is a significant public health problem in the United States, which affects children as well as adults. During 2010-2017, maternal opioid-related diagnoses increased approximately 130%, from 3.5 to 8.2 per 1,000 hospital deliveries, and neonatal abstinence syndrome (NAS) increased 83%, from 4.0 to 7.3 per 1,000 hospital deliveries (1). NAS, a withdrawal syndrome, can occur among infants following in utero exposure to opioids and other psychotropic substances (2). In 2018, a study of six states with mandated NAS case reporting for public health surveillance (2013-2017) found that mandated reporting helped quantify NAS incidence and guide programs and services (3). To review surveillance features and programmatic development in the same six states, a questionnaire and interview with state health department officials on postimplementation efforts were developed and implemented in 2021. All states reported ongoing challenges with initial case reporting, limited capacity to track social and developmental outcomes, and no requirement for long-term follow-up in state-mandated case reporting; only one state instituted health-related outcomes monitoring. The primary surveillance barrier beyond initial case reporting was lack of infrastructure. To serve identified needs of opioid- or other substance-exposed mother-infant dyads, state health departments reported programmatic successes expanding education and access to maternal medication for opioid use disorder (MOUD), community and provider education or support services, and partnerships with perinatal quality collaboratives. Development of additional infrastructure is needed for states aiming to advance NAS surveillance beyond initial case reporting.

Placental cytochrome p450 (CYP450) enzymes and efflux transporters, P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), are critical for transfer of drugs from the placenta to maternal circulation.We sought to determine if differences exist inThis was a retrospective nested case control study from 2014 to 2019 at a single tertiary care center. The opioid-exposed cohort included pregnant women aged ≥18 years on maintenance methadone or buprenorphine with non-anomalous singleton fetuses and gestational age ≥33 weeks. Controls included pregnant women with no medication exposure delivering at ≥37 weeks. De-paraffinized placental sections, inclusive of the apical syncytiotrophoblast membrane, were labeled with monoclonal antibodies for aromatase, P-gp, and BCRP. Placentas were scored for the presence and intensity of staining using the Allred scoring schema. Data were analyzed using descriptive, parametric, and nonparametric statistics.One hundred and ten opioid-exposed neonates were included in this analysis (51Syncytiotrophoblast aromatase immunostaining scores were reduced in

Background Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. Methods We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. Results Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). Conclusions Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don’t forgo prenatal care for fear of punitive consequences.

We assessed the prevalence of neonatal abstinence syndrome (NAS) and fetal growth outcomes in neonates exposed to methadone compared to buprenorphine in utero. Three authors assessed the titles and abstracts of all potentially eligible studies. The selection criteria were randomized controlled trials and observational cohort studies from January 2000 to January 2020 which indexed and reported original data for occurrence of NAS and fetal growth outcomes in pregnant people who received methadone vs. buprenorphine treatment. The quality and possible bias of each study was assessed using the Cochrane-risk-of-bias tool. Data were pooled to compare the occurrence of NAS and fetal growth restriction among women who received methadone vs. buprenorphine treatment. Of the 106 articles screened, 1 randomized controlled trial and 5 observational cohort studies including 2041 pregnancies fulfilled the inclusion criteria. Buprenorphine is associated with less NAS and improved growth outcomes compared to methadone. (OR = 0.515; p-value < 0.001). Compared to methadone, buprenorphine is associated with less adverse neonatal outcomes in terms of gestational age at birth, birthweight, and head circumference. With the prevalence of NAS continuing to rise, this study adds to the expanding academic research aimed at creating safer treatment protocols.

Background Validation studies estimating the positive predictive value (PPV) of neonatal abstinence syndrome (NAS) have consistently suggested overreporting in hospital discharge records. However, few studies estimate the negative predictive value (NPV). Even slightly imperfect NPVs have the potential to bias estimated prevalences of rare outcomes like NAS. Given the challenges in estimating NPV, our objective was to evaluate whether the PPV was sufficient to understand the influence of NAS misclassification bias on conclusions of the NAS prevalence in surveillance research. Methods We used hospital discharge data from the 2016 New Jersey State Inpatient Databases, Healthcare Cost and Utilization Project. We adjusted surveillance data for misclassification using quantitative bias analysis models to estimate the expected NAS prevalence under a range of PPV and NPV bias scenarios. Results The 2016 observed NAS prevalence was 0.61%. The misclassification-adjusted prevalence estimates ranged from 0.31-0.91%. When PPV was assumed to be ≥90%, the misclassification-adjusted prevalence was typically greater than the observed prevalence but the reverse was true for PPV≤70%. Under PPV 80%, the misclassification-adjusted prevalence was less than the observed prevalence for NPV>99.9% but flipped for NPV Conclusions When we varied the NPV below 100%, our results suggested that the direction of bias (over-or underestimation) was dependent on the PPV, and sometimes dependent on the NPV. However, NPV was important for understanding the magnitude of bias. This study serves as an example of how quantitative bias analysis methods can be applied in NAS surveillance to supplement existing validation data when NPV estimates are unavailable.

ObjectiveTo test the hypothesis that cerebral blood flow (CBF) assessed with arterial spin labelling (ASL) MRI is increased and standardised neurological examination is altered in infants with neonatal opioid withdrawal syndrome (NOWS) compared with those without.DesignProspective cohort study.SettingLevel IV neonatal intensive care unit and outpatient primary care centre.ParticipantsInfants with NOWS receiving pharmacological treatment and unexposed controls matched for gestational age at birth and post-menstrual age at MRI.Main outcomesCBF assessed by ASL on non-sedated 3-Tesla MRI and standardised Hammersmith Neonatal Neurological Examination (HNNE) within 14 days of birth.ResultsThirty infants with NOWS and 31 control infants were enrolled and included in the final analysis. Global CBF across the brain was higher in the NOWS group compared with controls (14.2 mL/100 g/min±5.5 vs 10.7 mL/100 g/min±4.3, mean±SD, Cohen’s d=0.72). HNNE total optimality score was lower in the NOWS group compared with controls (25.9±3.6 vs 28.4±2.4, mean±SD, Cohen’s d=0.81). A penalised logistic regression model including both CBF and HNNE items discriminated best between the two groups.ConclusionsIncreased cerebral perfusion and neurological examination abnormalities characterise infants with NOWS compared with those without intrauterine drug exposure and suggest prenatal substance exposure affects fetal brain development. Identifying neurological and neuroimaging characteristics of infants with NOWS can contribute to understanding mechanisms underlying later outcomes and to designing potential new treatments.

Purpose The purpose of this study was to examine patterns of health and developmental outcomes in children with prenatal opioid exposure (POE) and neonatal abstinence syndrome (NAS) compared to children without exposure during the first three years of life. Design and methods This was a secondary data analysis of the Maternal and Infant Data Hub (MIDH), a de-identified dataset originating from the Midwest region of the United States, consisting of newborn billing records and corresponding maternal and child electronic medical records. For these analyses, the repository included data on more than 20,000 children born between 2013 and 2019. Diagnoses were identified with International Classification of Diseases, ninth and tenth Revision, Clinical Modification codes (ICD-9/10-CM). Firth logistic regression was used to assess whether incidence of each diagnosis code differed by exposure group. Results Among 20,389 children in the dataset, 13,173 were unexposed; 455 were POE, and 199 were POE + NAS. There were significant differences in frequency of diagnoses between groups, specifically regarding growth and development, infection, mental health, musculoskeletal, neonatal, sensory, and social issues. When comparing exposed groups, children with POE + NAS experienced more negative health outcomes than children with only POE across all years. Conclusions This study implicates POE as a significant variable associated with many health and developmental outcomes of children during the first three years of life. Practice implications It is crucial to understand and identify health risks observed more frequently in exposed children during such a critical period of growth and brain development.

Aim This concept analysis aimed to offer insight into how opioid exposure affects the quality and construction of the maternal-infant bond. Background Maternal-infant bonding can be influenced by maternal opioid use disorder and the neonatal intensive care unit environment. Many interventions for mothers with opioid use disorder focus on enhancing parental skills, but often the emotional and relational features of the maternal-infant bond have been overlooked. Data source Literature from Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and PsycINFO published from January 2011 to June 2021 using "attachment theory," "mother-infant attachment," "maternal-infant bonding," "neonatal opioid withdrawal syndrome," and "neonatal abstinence syndrome" as key terms. Review methods Rodgers' method of concept analysis was used to determine the antecedents, attributes, and consequences of maternal-infant bonding. Results The key attributes of bonding for the opioid-exposed mother-infant dyad are engaged mothering, recognition of risk, affection, and respectful maternity care. The antecedents are closeness, selflessness, and purposeful touch. The consequences are sobriety, custody, love, and security.

Opioid use in the perinatal period has escalated rapidly, with potentially devastating outcomes for perinatal persons and infants. Substance use treatment is effective and has the potential to greatly improve clinical outcomes; however, characteristics of care received from providers including nurses have been described as a barrier to treatment. Our purpose was to describe supportive perinatal care experiences of persons with opioid use disorder. A qualitative descriptive study design was used to examine experiences of 11 postpartum persons (ages 22-36 years) in medication-assisted treatment for opioid use disorder at an academic medical center in the southern region of the United States. Participants were interviewed about experiences with perinatal and neonatal care during the child's hospitalization for neonatal abstinence syndrome surveillance and/or treatment. Four themes of supportive care experiences emerged: informing, relating, accepting, and holistic supporting. Participants reported a range of positive and negative perinatal care experiences, with examples and counterexamples provided. This fuller understanding of perceptions and lived experiences of care can inform practice changes and educational/training priorities. Future research is needed to facilitate development of comprehensive care models geared to address perinatal care needs of persons with opioid use disorder.

Background Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population.

Objective: Laryngomalacia (LM) is the most common congenital anomaly of the larynx. The cause of LM is still largely unknown, but a neurological mechanism has gained the most acceptance. There have not been any studies examining the prevalence of LM in infants with Neonatal Abstinence Syndrome (NAS). The aim of our study is to determine if infants with NAS are more likely to be diagnosed with LM. Methods: This study was a population-based inpatient registry analysis. We examined nationwide neonatal discharges in 2016 using the Kids’ Inpatient Database (KID). Only patients listed as neonates were included. The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) and diagnoses denoting LM were used. To quantify associations between the LM and NAS groups, prevalence rates and odds ratios (ORs) were used. Results: There were 3 970 065 weighted neonatal discharges in the 2016 KID. Among patients included in our dataset, 0.809% (32 128) had NAS and 0.075% (2974) had LM. There was an increased odds ratio for neonates with NAS and LM (OR of 2.85, 95% CI = 2.24-3.63) compared to infants without NAS. Multiple logistic regression accounting for possible confounders produced an adjusted OR of 1.68 (95% CI = 1.29-2.19). Conclusion: Our study found an association between NAS and LM. This suggests that prenatal exposure to opioids or possibly the sequelae of withdrawal symptoms may be risk factors for the development of LM.

ImportanceThe assessment of opioid withdrawal in the neonate, or neonatal opioid withdrawal syndrome (NOWS), is problematic because current assessment methods are based on subjective observer ratings. Crying is a distinctive component of NOWS assessment tools and can be measured objectively using acoustic analysis.ObjectiveTo evaluate the feasibility of using newborn cry acoustics (acoustics referring to the physical properties of sound) as an objective biobehavioral marker of NOWS.Design, Setting, and ParticipantsThis prospective controlled cohort study assessed whether acoustic analysis of neonate cries could predict which infants would receive pharmacological treatment for NOWS. A total of 177 full-term neonates exposed and not exposed to opioids were recruited from Women & Infants Hospital of Rhode Island between August 8, 2016, and March 18, 2020. Cry recordings were processed for 118 neonates, and 65 neonates were included in the final analyses. Neonates exposed to opioids were monitored for signs of NOWS using the Finnegan Neonatal Abstinence Scoring Tool administered every 3 hours as part of a 5-day observation period during which audio was recorded continuously to capture crying. Crying of healthy neonates was recorded before hospital discharge during routine handling (eg, diaper changes).ExposuresThe primary exposure was prenatal opioid exposure as determined by maternal receipt of medication-assisted treatment with methadone or buprenorphine.Main Outcomes and MeasuresNeonates were stratified by prenatal opioid exposure and receipt of pharmacological treatment for NOWS before discharge from the hospital. In total, 775 hours of audio were collected and trimmed into 2.5 hours of usable cries, then acoustically analyzed (using 2 separate acoustic analyzers). Cross-validated supervised machine learning methods (combining the Boruta algorithm and a random forest classifier) were used to identify relevant acoustic parameters and predict pharmacological treatment for NOWS.ResultsFinal analyses included 65 neonates (mean [SD] gestational age at birth, 36.6 [1.1] weeks; 36 [55.4%] female; 50 [76.9%] White) with usable cry recordings. Of those, 19 neonates received pharmacological treatment for NOWS, 7 neonates were exposed to opioids but did not receive pharmacological treatment for NOWS, and 39 healthy neonates were not exposed to opioids. The mean of the predictions of random forest classifiers predicted receipt of pharmacological treatment for NOWS with high diagnostic accuracy (area under the curve, 0.90 [95% CI, 0.83-0.98]; accuracy, 0.85 [95% CI, 0.74-0.92]; sensitivity, 0.89 [95% CI, 0.67-0.99]; specificity, 0.83 [95% CI, 0.69-0.92]).Conclusions and RelevanceIn this study, newborn acoustic cry analysis had potential as an objective measure of opioid withdrawal. These findings suggest that acoustic cry analysis using machine learning could improve the assessment, diagnosis, and management of NOWS and facilitate standardized care for these infants.

The prevalence of opioid use disorder (OUD) among pregnant women is increasing. Research consistently demonstrates the efficacy of medications for OUD (MOUD); however, researchers have called for additional studies evaluating the safety of MOUD during pregnancy, particularly the relative safety of two commonly used MOUD medications-methadone and buprenorphine. This study aimed to evaluate the consequences of MOUD exposure during pregnancy on risk for neonatal abstinence syndrome (NAS).In a clinical sample of infants born to women with OUD, we evaluated the risk of NAS among those exposed to (i) methadone and (ii) buprenorphine compared with those unexposed to MOUD, as well as the risk of NAS among those exposed to (i) methadone compared with those exposed to (ii) buprenorphine.Compared with buprenorphine-exposed infants (n = 37), methadone-exposed infants (n = 27) were at increased risk for NAS (odds ratio [OR] = 4.67, 95% confidence interval [CI]: 1.03, 21.17). Compared with unexposed infants (n = 43), buprenorphine-exposed infants were at decreased risk for NAS (OR = 0.45, 95% CI: 0.14, 1.39) and methadone-exposed infants were at increased risk for NAS (OR = 2.64, 95% CI: 0.79, 8.76), though these associations were not statistically significant.Our study suggests that when methadone and buprenorphine are equally appropriate options for the treatment of OUD in pregnant women, buprenorphine may add the additional benefit of reduced risk of newborn NAS.Medications for opioid use disorder (MOUD), such as buprenorphine and methadone, are effective in reducing the significant harms associated with untreated opioid use disorder (OUD) in nonpregnant and pregnant adults. While previous research clearly documents that the risks of MOUD in pregnancy are less than the risks of untreated OUD in pregnancy, researchers have called for additional studies evaluating the safety of MOUD during pregnancy, particularly the relative safety of methadone and buprenorphine. In a clinical sample of infants born to women with OUD, we showed that buprenorphine-exposed infants were at significantly reduced risk for neonatal abstinence syndrome compared with methadone-exposed infants. Our study adds to the growing body of evidence supporting the use of buprenorphine over methadone for the treatment of OUD among pregnant women.

Neonates born to mothers taking opioids during pregnancy are at risk for neonatal opioid withdrawal syndrome (NOWS), for which there is no recognized standard approach to care. Nonpharmacologic treatment is typically used as a first-line approach for management, and pharmacologic treatment is added when clinical signs are not responding to nonpharmacologic measures alone. Although morphine and methadone are the most commonly used pharmacotherapies for NOWS, buprenorphine has emerged as a treatment option based on its pharmacologic profile and results from initial single site clinical trials. The objective of this report is to provide an overview of NOWS including a summary of ongoing work in the field and to review the state of the science, knowledge gaps, and practical considerations specific to the use of buprenorphine for the treatment of NOWS as discussed by a panel of experts during a virtual workshop hosted by the National Institutes of Health.

BACKGROUND: Postpartum is a highly vulnerable time for women with opioid use disorder (OUD). Our primary objective was to identify patient and provider reported aspects of the pregnancy to postpartum transition that impact recovery progress for postpartum women receiving medication for opioid use disorder (MOUD). METHODS: This qualitative study consisted of semi-structured interviews with postpartum women in OUD treatment (n = 12) and providers (n = 9) at an outpatient addiction clinic. Interviews were transcribed and analyzed using an editing style approach to report themes and quotes. RESULTS: Patients and providers identified different themes that both promote and challenge recovery during the postpartum transition. These comprised of clinical factors, including MOUD, neonatal opioid withdrawal syndrome (NOWS) and pain associated with labor and delivery as well as psychosocial factors, such as role of a support system, mental health aspects of anxiety and depression causing mood changes, stigma and mistrust among healthcare providers and child welfare. CONCLUSIONS: Patients receiving MOUD and their providers identified multiple aspects unique to the postpartum transition that substantially strengthen and/or oppose OUD recovery. These aspects impacting recovery include factors specific to the receipt of MOUD treatment and those not specific to MOUD, yet tied to the postpartum state. Overall, these findings provide insight into areas for future research focused on identifying opportunities to promote recovery-oriented care for families affected by OUD.

Purpose To improve outcomes of infants with neonatal abstinence syndrome (NAS) by implementing an evidence-based approach to care. Methods An interdisciplinary team developed and implemented an educational module about the elements and principles of trauma-informed care (TIC) and standardized education on NAS for mothers with substance use disorder (SUD). The team collaborated with community behavioral health professionals to secure the services of a certified recovery specialist. Primary outcome measures of average length of stay (LOS) and admissions to special care nursery (SCN) for NAS infants were analyzed. Results Following health care team education on TIC and implementation of the standardized NAS brochure, average LOS decreased significantly from 6.5 to 5.1 days from baseline period (January-December 2019) to the implementation period (February-June 2020; p = 0.03). There was no difference in SCN admission from the baseline period (February-June 2019) to the implementation period (February-June 2020). Referrals to certified recovery specialists did not change. Clinical implications Education on the impact of trauma on new mothers with SUD can promote collaboration between them and the neonatal team. Standardizing education for new mothers of infants with NAS can help to engage families of infants with NAS and improve clinical outcomes.

Background The opioid epidemic in the United States continues to threaten public health. As a result of this crisis, neonatal opioid withdrawal syndrome (NOWS) has risen exponentially and requires a multitude of non-pharmacologic treatments to ensure healthy neonatal outcomes. Methods This feasibility study implemented an acupressure protocol as informed by the Near-Term Infant (NTI) conceptual framework for the treatment of NOWS. Aims of this study were to assess provider training, effective integration of acupressure within the standard of care, and acceptance of this treatment by mothers and healthcare providers. Results With maternal consent, a total of 12 participants were enrolled and underwent auricular acupressure. Nurse Practitioners were credentialed (75%) and effectively administered neonatal acupressure (100%) in accordance with the study protocol. Mothers were very satisfied with acupressure for the treatment of NOWS (Client Satisfaction Questionaire-8 mean scores 3.8–4.0 of a possible 4.0), and the majority of healthcare providers were supportive (66%, mean scores 3.6 to 4.0 out of possible 5). Conclusions Auricular acupressure was successfully implemented within the standard of care for NOWS. Future studies should incorporate outlined suggestions and include qualitative measures of acceptance as well as randomized controlled trials to evaluate efficacy.

BACKGROUND: Facilitating maternal-newborn involvement and care is critical for improving outcomes for perinatal individuals receiving opioid agonist therapy (OAT) and newborns experiencing Neonatal Abstinence Syndrome (NAS). Comprehensive education strategies are needed to prepare pregnant individuals receiving OAT for navigating the perinatal period. OBJECTIVES: Identify facilitators to successful care of perinatal individuals receiving OAT and newborns experiencing NAS via interviews with perinatal individuals and healthcare providers. The goal of identifying this information is to inform a future educational tool development. METHODS: Ten perinatal individuals receiving OAT and ten healthcare providers participated in interviews conducted via phone or video conference using semi-structured, open-ended questions. Data were analyzed separately for the two groups and later merged across samples using a qualitative descriptive content analysis approach to identify themes. RESULTS: Under the overarching theme of empowerment to improve outcomes for perinatal women, four themes arose from perinatal and provider interviews: 1) Preparation for Child Protective Services (CPS) involvement, 2) Healthcare providers shape experience through stigma and support 3) Caring for newborns with NAS, and 4) Managing health and resources during postpartum. CONCLUSION: Perinatal participants emphasized the importance of self-advocacy while navigating healthcare and social systems. Providers highlighted the importance of communicating expectations to empower patients. Education is needed for pregnant individuals receiving OAT on what to expect during pregnancy and postpartum, as well as for providers to help them optimally support their perinatal patients receiving OAT.

OBJECTIVE We examined weight loss patterns and feeding practices of infants hospitalized for neonatal opioid withdrawal syndrome (NOWS) managed by the eat, sleep, console approach, which emphasizes nonpharmacologic treatment. Although feeding practices during hospitalization vary widely, weight loss patterns for infants managed under this approach have not yet been described. METHODS Of 744 infants with NOWS born from 2014 to 2019 at our institution, 330 met inclusion criteria (≥35 weeks’ gestation and no NICU transfer). We examined maximum weight loss and created weight loss percentile curves by delivery type using mixed effects quantile modeling with spline effect for hour of life; 95% confidence intervals (CI) were compared to published early weight loss nomograms. RESULTS In the cohort, the mean gestational age was 39.2 weeks, mean birth weight was 3.1 kg, and mean length of stay was 6.5 days; 94.6% did not require pharmacologic treatment. Median percent weight loss was significantly more compared to early weight loss nomograms for both vaginally-delivered infants at 48 hours (6.9% [95% CI: 5.8–8.5] vs 2.9%) and cesarean-delivered infants at 48 hours (6.5% [95% CI: 4.1–9.1] vs 3.7%) and 72 hours (7.2% [95%CI 4.7–9.9] vs 3.5%), all P < .001. Overall, 27.9% lost >10% birth weight. CONCLUSIONS We demonstrate weight loss patterns of infants with NOWS managed by the eat, sleep, console approach at a single center. Infants with NOWS lose significantly more weight than nonopioid exposed infants and are at increased risk of morbidity and health care use. Studies to address optimal feeding methods in these infants are warranted.

Hospital and community healthcare providers have expressed concerns around the continuity and quality of care for infants with neonatal abstinence syndrome (NAS) during hospitalization and transition home. This qualitative study explored the experiences of hospital and community-based healthcare providers and identified themes related to the management of NAS for mothers and infants. Healthcare providers that cared for women with substance use disorders and/or cared for newborns with NAS in a large urban setting in Canada met inclusion criteria for this study and were interviewed in groups or as individuals. Interview transcripts were reviewed iteratively using inductive thematic analysis to identify an overarching theme linked with primary themes. In total, 45 healthcare providers were interviewed. Qualitative analysis of their experiences derived the overarching theme of hope with five primary themes being: mother/infant, mental health, system, judgement, and knowledge. The study identified gaps in NAS care including fear, stigma, and language. This research demonstrates that programs and interventions that work with mothers and newborns with NAS must foster hope in mothers, families, and in the extended care provider team and improve communication between hospital and community networks.

Untreated opioid misuse in pregnancy is associated with adverse outcomes. Limited information is available on maternal and perinatal outcomes in subsequent pregnancies for individuals initiated on medication for opioid use disorder (MOUD) in a prior pregnancy.Evaluate maternal and neonatal outcomes in subsequent pregnancies for individuals initiated on MOUD in prior pregnancy.Historical cohort study including individuals with opioid use disorder with ≥2 pregnancies between 2013 and 2020, received care in our colocated multidisciplinary clinic for1 pregnancy, and delivered at our institution. Primary outcome was rate of preconception MOUD. Secondary outcomes included rate of neonatal opioid withdrawal syndrome requiring pharmacologic treatment and length of hospital stay.Forty-two individuals with opioid use disorder in their index pregnancies (n = 42) and 46 subsequent pregnancies were identified. Individuals were more likely to receive long-acting reversible contraception in subsequent pregnancies (35% vs 14%, P = 0.04). No differences in tobacco use, gestational age at initiation of prenatal care or delivery was noted. Individuals in their subsequent pregnancies were 6 times more likely to be on MOUD preconception (78% vs 36%; OR, 6.48; [95% CI, 2.52-16.64]) and 67% less likely to have positive illicit urine drug screen upon initiation of care (36% vs 64%; OR, 0.33; 95% [CI, 0.14-0.78]). Neonates had similar rates of neonatal abstinence withdrawal syndrome requiring pharmacological treatment, positive illicit toxicology results, and neonatal length of stay.Participation in multidisciplinary obstetric and opioid use disorder program increases rate of MOUD in subsequent pregnancy with decrease in illicit drug use.

The Neonatal Abstinence Syndrome (NAS) is defined as the situation of newborns who were exposed to different types of substances used by their mothers while pregnant, that is, still in their intrauterine phase, making them physically dependent on them, which can cause malformations and harmful effects to the nervous, gastrointestinal and respiratory systems. Objective: To characterize neonates affected by withdrawal syndrome and to list the types of psychoactive drugs that most affect them and their clinical manifestations. Methodology: Integrative review study with search in electronic databases SCIELO, PUBMED and VHL, from 2011 to 2021, without language restrictions. Results and Discussion: It was possible to identify the characteristics of newborns with substance abuse withdrawal syndrome, as well as to list the clinical manifestations that these newborns present, according to the type of substance used by the mother during pregnancy. It was also noted the importance of the multidisciplinary team when dealing with this pathology and the difficulty in making a diagnosis, since this is a subject that has not been so widely studied. Final considerations: In view of the actions analyzed, it was noted the importance of implementing strategies aimed at exploring the characteristics that these newborns present when exposed to narcotic substances during intrauterine life, thus facilitating the evaluation and early detection of this syndrome. El Síndrome de Abstinencia Neonatal (SAN), se define como la situación de los recién nacidos que han sido expuestos a diferentes tipos de sustancias usadas por la madre durante la gestación, o incluso en su fase intrauterina, por lo que presentan dependencia física de las madres, pudiendo causar malformaciones y efectos nocivos en el sistema nervioso, gastrointestinal y respiratorio. Objetivo: Caracterizar a los neonatos acometidos con el síndrome de abstinencia y determinar los tipos de psicoanálisis que más los acomete y sus respectivas manifestaciones clínicas. Metodología: Estudio de revisión integradora con búsqueda en bases de datos electrónicas SCIELO, PUBMED y BVS, desde 2011 hasta 2021, sin restricciones de idioma. Resultados y Discusión: Se logró identificar las características de los neonatos con síndrome de abstinencia por abuso de sustancias, así como enumerar las manifestaciones clínicas que presentan estos recién nacidos, según el tipo de sustancia consumida por la madredurante el embarazo. También se señaló la importancia del equipo multidisciplinar frente a esta patología y la dificultad de cerrar el diagnóstico de la misma, por ser un tema no tan estudiado. Consideraciones finales: En las acciones analizadas se observa la importancia de implementar estrategias que permitan explorar de forma amplia las características que presentan estos RN's cuando se exponen a sustancias entorpecedoras en la fase de vida intrauterina, facilitando así la evaluación y detección precoz de dicho síndrome. A Síndrome de Abstinência Neonatal (SAN) é definida como a situação dos recém-nascidos que foram expostos a diferentes tipos de substâncias usadas pela mãe enquanto gestante, ou seja, ainda em sua fase intrauterina, fazendo com que estes apresentem dependência física às mesmas, podendo causar malformações e efeitos nocivos ao sistema nervoso, gastrointestinal e respiratório. Objetivo: Caracterizar os neonatos acometidos com a síndrome de abstinência e elencar os tipos de psicoativos que mais os acometem e suas respectivas manifestações clínicas. Metodologia: Estudo de revisão integrativa com busca nas bases de dados eletrônicas SCIELO, PUBMED e BVS, nos períodos de 2011 a 2021, sem restrições de idiomas. Resultados e Discussão: Foi possível identificar as características dos neonatos portadores da síndrome de abstinência por uso de substâncias psicoativas, bem como, elencar as manifestações clínicas que esses recém-nascidos apresentam, de acordo com o tipo de substância utilizada pela mãe durante a gestação. Notou-se ainda a importância da equipe multidisciplinar frente a essa patologia e a dificuldade de fechar o diagnóstico para tal, por se tratar de uma temática não tão estudada. Considerações finais: Diante das ações analisadas nota-se a importância de implementar estratégias que visem explorar de forma ampla as características que esses RN’s apresentam quando expostos a substâncias entorpecentes na fase de vida intrauterina, facilitando assim a avaliação e detecção precoce dessa síndrome.

Objective: It is known that the use of alcohol, illicit drugs and psychoactive substances during pregnancy is significantly associated with maternal, fetal and neonatal morbidities. We planned to investigate the characteristics of babies born to mothers who use illicit substances.Method: Babies born to mothers using illicit drugs and healthy babies born between September 2019 and December 2021 were included in the study. Demographic, clinical and laboratory data of the patients and modified Finnegan scores were recorded retrospectively from the file data.Results: A total of 24 infants, 11 infants of drug-using mothers and 13 healthy infants in the control group, were included in the study. Ages of mothers, gestational weeks, birth weights, and APGAR scores at 1st and 5th minutes of babies born to mothers who used substance were found to be statistically lower than healthy babies. The rates of leukopenia and neutropenia were found to be significantly higher in patients with a modified Finnegan score ≥8 and in need of morphine (n:4/11) compared to patients without morphine need (n:7/11).Conclusion: There is a need for detailed studies on the prevention of illicit substance use as a current health problem, the development of policies on early detection and follow-up, and the search for new biomarkers for the early detection of infants followed for neonatal withdrawal syndrome., Amaç: Gebelik döneminde alkol, yasadışı uyuşturucu ve psikoaktif madde kullanımının önemli ölçüde maternal, fetal ve neonatal morbiditelerle ilişkili olduğu bilinmektedir. Yasadışı madde kullanan anneden doğan bebeklerin özelliklerini araştırmayı planladık.Yöntem: Çalışmaya Eylül 2019 ve Aralık 2021 tarihleri arasında doğan yasadışı uyuşturucu madde kullanan anne bebekleri ve kontrol grubu olarak sağlıklı bebekler dahil edildi. Hastaların demografik, klinik ve laboratuvar verileri ile modifiye Finnegan skorları retrospektif olarak dosya verilerinden kaydedildi.Bulgular: Çalışmaya uyuşturucu madde kullanan anne bebeği 11 ve kontrol grubuna 13 sağlıklı bebek olmak üzere toplam 24 bebek dahil edildi. Madde kullanan annelerin yaşları, gebelik haftaları, doğum ağırlıkları, 1. ve 5. dakikada APGAR skorları sağlıklı bebeklerden istatistiksel olarak daha düşük bulundu. Modifiye Finnegan skoru ≥8 olup morfin ihtiyacı olan (n:4/11) hastalarda lökopeni ve nötropeni oranı morfin ihtiyacı olmayan (n:7/11) hastalara göre anlamlı olarak yüksek bulundu.Sonuç: Güncel sağlık problemi olarak yasadışı madde kullanımının önlenmesi, erken tespit ve izlemi konusunda politikaların geliştirilmesi ve neonatal yoksunluk sendromu açısından izlenen bebeklerin erken tespiti için yeni biomarkerların araştırılması konusunda detaylı çalışmalara ihtiyaç vardır.

As the United States faces the repercussions of the current opioid epidemic, it is important for social workers to be able to identify risks for poor birth outcomes in infants with neonatal abstinence syndrome (NAS). Although some studies have identified single risk factors, no studies have tested associations between total amount of risk (that is, cumulative risk) and birth outcomes in infants with NAS. Authors examined 318 mothers who used opioids during pregnancy and their infants’ birthweight, length, head circumference, and Apgar scores (which measure overall infant health after birth). All infants were admitted to a neonatal intensive care unit in Appalachia and were diagnosed with NAS. Authors found that high cumulative risk during pregnancy was associated with lower birthweight and Apgar scores one and five minutes after birth as well as shorter length and smaller head circumference at birth. Social workers are encouraged to assess for the quantity of prenatal adversity experienced by the mothers they serve and to consider multicomponent, comprehensive community-based interventions to reduce cumulative risk.

Background: Little is known about rates of substance use disorder (SUD) treatment for women in dyads affected by substance use in the immediate postpartum period. This study's objectives were to (1) identify characteristics of mothers of infants with neonatal abstinence syndrome (NAS) and/or prenatal substance exposure (PSE) who did or did not receive SUD treatment in the first 60 days postpartum and (2) describe timing of treatment receipt. Methods: This descriptive study examined linked mother–infant dyads using Medicaid data from Louisiana, Massachusetts, and Wisconsin for 2006–2009. Dyads were included if the infant had NAS and/or PSE. Descriptive statistics on sociodemographic characteristics, prenatal SUD, mental health conditions, Medicaid enrollment, and health care utilization were reported for women who did and did not receive SUD treatment in the first 60 days postpartum. The distribution of each variable was compared using chi-square tests. The timing of first postpartum treatment in weeks since delivery was examined. Results: Among Medicaid-insured women whose infants had in utero substance exposure, 15% received any postpartum SUD treatment. Fewer than half were diagnosed with SUD prenatally. Of those who received postpartum SUD treatment, 68% had received prenatal treatment. No association was observed between postpartum SUD treatment receipt and months of Medicaid enrollment in the year before delivery, prenatal visits, or postpartum visit attendance. Conclusions: Most women who likely need postpartum SUD treatment did not receive it and multipronged solutions are needed. These findings provide a useful baseline for evaluations of policies aimed at improving maternal health.

In this paper, we review the management of neonatal opioid withdrawal syndrome (NOWS) and clinical pharmacology of primary treatment agents in NOWS, including morphine, methadone, buprenorphine, clonidine, and phenobarbital. Pharmacologic treatment strategies in NOWS have been mostly empirical, and heterogeneity in dosing regimens adds to the difficulty of extrapolating study results to broader patient populations. As population pharmacokinetics (PKs) of pharmacologic agents in NOWS become more well‐defined and knowledge of patient‐specific factors affecting treatment outcomes continue to accumulate, PK/pharmacodynamic modeling and simulation will be powerful tools to aid the design of optimal dosing regimens at the patient level. Although there is an increasing number of clinical trials on the comparative efficacy of treatment agents in NOWS, here, we also draw attention to the importance of optimizing the dosing regimen, which can be arguably equally important at identifying the optimal treatment agent.

Opioid abuse during pregnancy can result in Neonatal Opioid Withdrawal Syndrome (NOWS). We investigated genome-wide methylation analyses of 96 placental tissue samples, including 32 prenatally opioid-exposed infants with NOWS who needed therapy (+Opioids/+NOWS), 32 prenatally opioid-exposed infants with NOWS who did not require treatment (+Opioids/-NOWS), and 32 prenatally unexposed controls (-Opioids/-NOWS, control). Statistics, bioinformatics , Artificial Intelligence (AI), including Deep Learning (DL), and Ingenuity Pathway Analyses (IPA) were performed. We identified 17 dysregulated pathways thought to be important in the pathophysiology of NOWS and reported accurate AI prediction of NOWS diagnoses. The DL had an AUC (95% CI) =0.98 (0.95–1.0) with a sensitivity and specificity of 100% for distinguishing NOWS from the +Opioids/-NOWS group and AUCs (95% CI) =1.00 (1.0–1.0) with a sensitivity and specificity of 100% for distinguishing NOWS versus control and + Opioids/-NOWS group versus controls. This study provides strong evidence of methylation dysregulation of placental tissue in NOWS development.

OBJECTIVES: The Modified Finnegan Neonatal Abstinence Scoring System (M-FNASS) and the newer Eat, Sleep, and Console (ESC) model guide the clinical management of neonatal opioid withdrawal syndrome (NOWS). In this study, we evaluate how the M-FNASS and ESC model directly compare in inpatient practice. We hypothesized that ESC scores would correlate with M-FNASS scores, whereas ESC management would reduce health care use for infants with NOWS. METHODS: In this retrospective cohort study, we compared management of infants with NOWS admitted to nursery settings. Epoch 1 was managed by using an M-FNASS algorithm. Epoch 2 was scored simultaneously with the M-FNASS and ESC model and managed by using the ESC approach. In the statistical analysis, we compared M-FNASS and ESC scores and outcomes between epochs. RESULTS: A total of 158 infants provided 2101 scoring instances for analysis. Demographic characteristics were similar between epochs. ESC scores significantly correlated with overall M-FNASS scores and specific M-FNASS domains. Receiver operating characteristic (ROC) curve analysis revealed that an ESC score containing at least 1 “no” was best predicted by an M-FNASS cutoff value of 7.5 (sensitivity 0.84; specificity 0.70; area under the curve = 0.842). Length of stay (median 9.5 vs 5 days; P = .0002) and initiation (53% vs. 33%; P = .018) and duration of pharmacologic treatment (median 11 vs 7 days; P = .0042), as well as length of stay for infants who were pharmacologically treated (median 15 vs 10 days; P = .0002), were significantly reduced with ESC-based management after adjustment for covariates. CONCLUSIONS: The ESC approach meaningfully correlates with the M-FNASS to detect NOWS. Management with the ESC approach continues to be associated with reduced health care use when compared with an M-FNASS approach, implying that the ESC approach may facilitate higher-value inpatient care.

BACKGROUND: At our institution, the treatment of infants with neonatal abstinence syndrome (NAS) is guided by a function-based assessment called the Eat, Sleep, Console (ESC) approach. Infants room in with their parent(s) on the inpatient units, and most infants are treated exclusively with nonpharmacologic interventions. The experience of parents of infants with NAS treated with the ESC approach is unknown. METHODS: We chose a deductive, hypothesis-driven approach to perform a content analysis of transcripts from in-depth, semistructured interviews of parents of infants with NAS in our institution. Responses were audiotaped, transcribed, and reviewed by at least 3 members of the research team. RESULTS: We interviewed 18 parents of infants with NAS. Most participants were ≥30 years, were white, and had a high school or equivalent level of education. Four major themes emerged: (1) parents were supportive of fewer interventions and normalizing of newborn care in the ESC approach; (2) parents felt encouraged to lead their infant’s NAS care; (3) parents perceived gaps in communication about what to expect in the hospital immediately after delivery and during their infant’s hospital stay; and (4) parents experienced feelings of guilt, fear, and stress and expressed the need for increased support. CONCLUSIONS: Parents in our study had an overall positive experience with the ESC approach. This engagement probably contributes to the success of the ESC approach in our institution. Future opportunities include better preparation of expectant mothers and continued emotional support after delivery.

Background Neonatal Opioid Withdrawal Syndrome (NOWS) is a significant public health issue and while millions of neonates are affected each year, an optimal pharmacologic weaning protocol has yet to be demonstrated. In this study, we compare hospital length of stay (LOS) and length of treatment (LOT) for treatment of neonatal opioid withdrawal (NOWS) with morphine versus methadone. Methods This was a single-site, open-label, randomized controlled pilot study conducted from October 2016-September 2018. Infants were eligible if their primary in-utero drug exposure was heroin, oral opioids, or methadone and they were born at greater than or equal to 34 weeks gestation. Infants were excluded for serious medical comorbidities and primary in-utero exposure to buprenorphine. Results Sixty-one infants were enrolled; 30 were randomized to methadone treatment, and 31 to morphine treatment. Overall 46% of infants required treatment for NOWS. LOS and LOT for infants treated with morphine was 17.9 days and 14.7 days respectively, compared to 16.1 days and 12.8 days for babies treated with methadone (p = 0.5, p = 0.54). Infants treated with morphine received lower total morphine equivalents than those treated with methadone (9.7 vs. 33, p Conclusions Infants treated with morphine versus methadone had no significant differences in LOS or LOT in this pilot study. Infants treated with methadone received up to 3 times the opioid based on morphine equivalents as infants treated with morphine and had more transfers to the NICU for over sedation. Clinical trial registration Morphine Versus Methadone for Opiate Exposed Infants With Neonatal Abstinence Syndrome NCT02851303, initiated 01/08/2016.

Adverse childhood experiences and overdose are linked in a cycle that affects individuals and communities across generations. The Centers for Disease Control and Prevention's Overdose Data to Action cooperative agreement supports a comprehensive public health approach to overdose prevention and response activities across the U.S. Exposure to traumatic events during childhood can increase the risk for myriad health outcomes, including overdose; therefore, many Overdose Data to Action recipients leveraged funds to address adverse childhood experiences.In 2021, an inventory of Overdose Data to Action‒funded activities implemented in 2019 and 2020 showed that 34 of the 66 recipients proposed overdose prevention activities that support people who have experienced adverse childhood experiences or that focus on preventing the intergenerational transmission of adverse childhood experiences. Activities were coded by adverse childhood experience prevention strategy, level of the social ecology, and whether they focused on neonatal abstinence syndrome.Most activities among Overdose Data to Action recipients occurred at the community level of the social‒ecologic model and under the intervene to lessen harms adverse childhood experience prevention strategy. Of the 84 adverse childhood experience‒related activities taking place across 34 jurisdictions, 44 are focused on neonatal abstinence syndrome.Study results highlight the opportunities to expand the breadth of adverse childhood experience prevention strategies across the social ecology. Implementing cross-cutting overdose and adverse childhood experience‒related activities that span the social‒ecologic model are critical for population-level change and have the potential for the broadest impact. Focusing on neonatal abstinence syndrome also offers a unique intervention opportunity for both adverse childhood experience and overdose prevention.