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Neonatal-Perinatal Health Care Delivery: Practices and Procedures

Neonatal-Perinatal Health Care Delivery 1: Practices: Antenatal Consultation, Substance Use, Potpourri

725 - Early Discharge and the Use of Telemedicine to Monitor Newborns at Risk for Neonatal Opioid Withdrawal Syndrome (NOWS)

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 725
Publication Number: 725.244

Robert W. Rothstein, University of Massachusetts Medical School, Springfield, MA, United States; Jenevieve Nishimwe, Tufts University, springfield, MA, United States; Rachana Singh, Tufts University School of Medicine, Boston, MA, United States

Presenting Author(s)

Robert W. Rothstein, MD

Neonatologist
University of Massachusetts Medical School
Springfield, Massachusetts, United States

Background: The opioid epidemic is associated with an increase in substance exposed newborns (SEN’s) being observed and/or treated for Neonatal Opioid Withdrawal Syndrome (NOWS), with increased hospital lengths of stay (LOS), costs and resource utilization. A 5-7 day inpatient observation of asymptomatic SEN’s to longer half-life opioids, like heroin, methadone and buprenorphine, is generally performed.

Objective:

We hypothesize that in a select cohort of mother-infant dyads (MID's) exposed to opioids, early discharge (D/C) by 96 hours of life (HOL) with home telemedicine monitoring can be performed safely, without increasing (1)abnormal ESC scores (2)outpatient pediatric calls and visits (3)readmission for NOWS and (4)post-partum depression (PPD). Furthermore, telemedicine monitoring facilitates transition to home including (1)stable newborn weight gain (2)EI referral and (3)maternal satisfaction in both confidence and safety when providing newborn care.

Design/Methods: Beginning May 2021, MID's were screened by Social Services with (n=19) meeting eligibility criteria including newborn medical stability per treating Pediatrician, Eat-Sleep-Console (ESC) scores supporting no pharmacological treatment, maternal stability in a Medically Assisted Treatment (MAT) program, has (-) Urine Tox for 4 months prior to delivery, has custody of her other biologic children and signs the Home Telemedicine Agreement. Mothers were trained in ESC scoring, weighing their newborns, and recording data in a password protected, HIPAA compliant, secure iPad provided by Locus Health. Daily, for 30 days post D/C, mothers enter data including ESC, weight, feeding, and need for outpatient physician care for NOWS. Surveys on EI, Edinburgh post-partum depression (PPD), and Program Satisfaction are recorded. Daily, the Neonatologist views the recorded metrics on the Locus Platform and while not directing care, can contact mother, Pediatrician or Obstetrician. Data from Locus is entered into REDCap.

Results:

Demographic data for the 19 MID's are listed (Table 1). All 19 newborns (Table 2) were D/C'd before 96 HOL, had stable outpatient ESC scores, weight, and received EI referrals. None required a provider phone call, examination or admission for NOWS. Despite a 73% maternal daily log in compliance and 42% survey response rate, 75% replying said Telemedicine improved confidence and safety. Telemedicine led to early identification of an at risk newborn for failure to thrive and a mother for PPD.

Conclusion(s):

In a select cohort of MID's exposed to opioids, telemedicine can safely facilitate early D/C by 96 HOL and successful transition to home.