Thomas Jefferson University Hospital recently hosted a conference organized by the U.S. Department of Health and Human Services (HHS) aimed to develop new guidelines for monitoring the long-term development of children who are born with Neonatal Abstinence Syndrome (NAS). The program also highlighted Jefferson’s Maternal Addiction Treatment Education & Research (MATER) program, which focuses on providing mothers with a variety of services including mental health and medical care, mindfulness, group and peer support, as well as care coordination and case management.
Dr. Neera Goyal, a pediatrician and researcher at Nemours/Alfred I. duPont Hospital for Children at Jefferson, shared her thoughts about these new guidelines, Jefferson’s impact on patients, disparities in care, factors that affect long-term development, and her role in impacting patients with NAS.
Q: Will the new HHS guidelines that are coming forth from the symposium have any future impact on how Jefferson cares for infants with NAS and their mothers?
A: The goal of Wednesday’s convening of experts was to gather consensus on common terminology and data measures that could be used for the longitudinal tracking of outcomes related to infant opioid exposure at a national scale. The development of such a database would facilitate clinicians and researchers at Jefferson and institutions across the US to further advance the care of this population, through clinical decision support, quality improvement, and research.
In addition, the Department of Health and Human Services has outlined a 5-point strategy as the basis for combating the opioid crisis. This includes:
- Improved access to prevention, treatment and recovery services
- Improved public health data and reporting
- Improvements in approaches to pain management that are evidence-based
- Increasing availability of overdose-reversing drugs
- Innovative research on pain and addiction
Q: What kind of work are Jefferson faculty, staff, and students doing to impact the lives of infants who are born with NAS as well as their mothers?
A: Jefferson’s MATER program continues to be at the forefront of comprehensive treatment models of care for pregnant and parenting mothers with substance use disorder. Jefferson was recently awarded a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) where Dr. Diane Abatemarco, the study’s Principle Investigator, seeks to build on this work by incorporating group prenatal care and pediatric care for families in residential treatment.
Researchers at Jefferson are also actively involved in investigating novel pharmacologic treatments to prevent severe withdrawal symptoms among opioid-exposed newborns after birth.
Researchers within the pediatric department were also recently awarded pilot grant funding to test the use of electronic health record data (PEDSNet) to study the impact of opioid exposure on health care utilization and outcomes in infancy and early childhood.
Q: Are there any gaps of care for infants with NAS and their mothers and if so, how does Jefferson address those disparities?
A: There are many gaps in care:
- Getting women with substance use disorders enrolled in medication-assisted treatment. The MATER program has a comprehensive, well-established program that seeks to reduce stigma and other barriers to seeking care.
- Across the US, there is substantial variation in how hospitals manage the care of opioid-exposed infants. Jefferson has an established, evidence-based protocol for neonatal monitoring and treatment.
- The availability of social support, peer mentoring, and care coordination after birth hospital discharge can be limited. The MATER program is working to expand on its existing array of services for mothers and infants, to better support their needs.
Q: Are there any biological, social, or environmental factors that can have an impact on the long-term outcomes of children with NAS? If so, how does Jefferson work to reduce the impact of those factors?
A: Multiple factors impact long-term outcomes for this population. Biological factors include maternal and infant medical comorbidities, details of the birth itself, the duration and type of fetal opioid exposure, and genetics. Social factors include other substance exposures, family demographics, and support systems, insurance and access to care, food insecurity, and housing stability. Environmental factors include stability and quality of the parent or caregiver relationship, home safety, and the capacity to promote child development and learning. For this population, comprehensive treatment like that provided at MATER involves not only medication-assisted treatment, but also case management, social support, parenting support, and advocacy for legal, financial, housing, and vocational needs.
Q: What is your role in working towards improving the lives of children affected by NAS? What kind of impact does your work have for those patients?
A: [I am a] clinician, and educator for pediatric trainees and students at Thomas Jefferson University, and a researcher focused on optimizing pediatric primary care for mothers and infants affected by substance use disorders. An enhanced model of care for this population would address the unique medical and developmental needs of exposed infants, be integrated with the mothers’ substance use disorder treatment program, and facilitate a trauma-informed approach to improving parenting.