News Release 

New study aims to improve outcomes for pregnancies impacted by opioid use disorder

Since 2012, birthing hospitals in Massachusetts started to identify and share best practices for pregnancies impacted by Opioid Use Disorder under the umbrella of Neonatal Quality Improvement Collaborative, to improve maternal-infant outcomes

Pediatric Academic Societies

BALTIMORE - A new study aims to actively involve birthing hospitals to improve health and social outcomes for the maternal infant dyads impacted by Opioid Use Disorder (OUD). Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24 - May 1 in Baltimore.

"Since 2016, the Perinatal-Neonatal Quality Improvement Network of Massachusetts along with other state level stakeholders, launched an initiative to actively involve birthing hospitals in the state to improve overall health and social outcomes for the maternal infant dyads impacted by OUD," said Dr. Rachana Singh, MD, one of the authors of the study. "This process included sharing best practices; a shared database to collect de-identified data; educational materials; serial webinars; biannual quality summits; sharing of statewide and comparative individual hospital reports; and hospital site visits."

All voluntarily participating hospitals were invited to identify, share and adopt best care practices as was feasible within the resources available. Commonly shared materials included: a shared database storing de-identified data; educational materials (antenatal screening tools; NAS toolkit; Eat, Sleep, Console scoring); webinars to share hospital-based successes; biannual quality summits; sharing of statewide and individual hospital reports; and hospital site visits. With these efforts, of the 47 birthing hospitals caring for mothers or newborns, over 30 are participating in this initiative, including 26 sharing data to the database since 2017.

Between January 2017 to November 2018, data for 1,434 maternal-infant dyads was reported in the central database. Of these, approximately 80% mothers with OUD were receiving medication assisted treatment (MAT) with <40% using illicit drugs during pregnancy, 69% opioid exposed newborns (OENs) received skin-to-skin care in the first 24 hours of life, 70% roomed-in for at least one night prior to maternal discharge and 80% of eligible OENs received any mother's milk during hospitalization. Less than or equal to 50% of OENs needed pharmacotherapy. The average hospital length of stay (LOS) for all OENs born greater than or equal to 37 weeks was approximately 14 days and while for those not requiring pharmacotherapy was approximately 6 days. Eighty percent of OENs were referred to early intervention prior to discharge and 72% of OENs were discharged home to a biologic parent. Significant increases in skin-to-skin contact (median 64.7% to 72.3%) and significant decreases in pharmacologic therapy (median 52.5 % to 45.8%) were seen by run chart rules.

This statewide multidisciplinary collaborative effort was able to engage a majority of birthing hospitals in improving care provision for OUD impacted pregnancies resulting in a trend toward less need for pharmacologic treatment through greater focus on non-pharmacologic methods.

Dr. Singh concluded, "Through these efforts we have been able to engage a majority of birthing hospitals in improving care provision for OUD impacted pregnancies resulting in a trend toward less need for pharmacologic treatment through greater focus on non-pharmacologic methods."

Dr. Singh will present findings from "Improving Outcomes for Pregnancies Impacted by Opioid Use Disorder: The Massachusetts Experience" on Monday, April 29 at 1 p.m. EDT. Reporters interested in an interview with Dr. Singh should contact PAS2019@piercom.com. Please note that only the abstracts are being presented at the meeting. In some cases, the researchers may have additional data to share with media.

The PAS 2019 Meeting brings together thousands of pediatricians and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2019 Meeting, please visit http://www.pas-meeting.org.

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: to improve the health and well-being of children worldwide. This international gathering includes pediatric researchers, leaders in pediatric academics, clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting will be the premier North American scholarly child health meeting. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2019, and like us on Facebook.

Abstract: Improving Outcomes for Pregnancies Impacted by Opioid Use Disorder: The Massachusetts Experience

Background: Since 2012, birthing hospitals in Massachusetts started to identify and share best practices for pregnancies impacted by Opioid Use Disorder (OUD) under the umbrella of Neonatal Quality Improvement Collaborative (neoQIC), to improve maternal-infant outcomes. In 2016, the Maternal Perinatal Quality Collaborative (MPQC), with state level stakeholders, joined the initiative to create the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN).

Objective: The overarching aim was to actively involve birthing hospitals to improve health and social outcomes for the maternal infant dyads impacted by OUD.

Design/Methods: All voluntarily participating hospitals were invited to identify, share and adopt best care practices as was feasible within the resources available. Commonly shared materials included - a shared database storing de-identified data; educational materials (antenatal screening tools; NAS toolkit; Eat, Sleep, Console scoring); webinars to share hospital based successes; biannual quality summits; sharing of statewide and individual hospital reports; and hospital site visits. With these efforts, of the 47 birthing hospitals caring for mothers or newborns, over 30 are participating in this initiative, including 26 sharing data to the database since 2017.

Results: Between 1/17 to 11/18 data for 1434 maternal-infant dyads was reported in the central database. Of these, approximately 80% mothers with OUD were receiving medication assisted treatment (MAT) with <40% using illicit drugs during pregnancy, 69% Opioid Exposed Newborns (OENs) received skin-to-skin care in the first 24 hours of life, 70% roomed-in for at least 1 night prior to maternal discharge and 80% of eligible OENs received any mother's milk during hospitalization [Fig 1]. Less than or equal to 50% of OENs needed pharmacotherapy [Fig 2]. The average hospital length of stay (LOS) for all OENs born greater than or equal to 37 weeks was approximately 14 days and while for those not requiring pharmacotherapy was approximately 6 days. 80% of OENs were referred to Early Intervention prior to discharge and 72% of OENs were discharged home to a biologic parent. Significant increases in skin-to-skin contact (median 64.7% to 72.3%) and significant decreases in pharmacologic therapy (median 52.5 % to 45.8%) were seen by run chart rules.

Conclusion(s): Our statewide multidisciplinary collaborative effort was able to engage a majority of birthing hospitals in improving care provision for OUD impacted pregnancies resulting in a trend toward less need for pharmacologic treatment through greater focus on non-pharmacologic methods.

Authors: Mary Houghton, Elisha Wachman, Munish Gupta, David Schiff, Lawrence Rhein, Alan Picarillo, Hafsatou Diop, Debra Bercuvitz, Ronald Iverson, Rachana Singh

Authors/Institutions: R. Singh, Newborn Medicine, Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts, UNITED STATES|M. Houghton, M. Gupta, Beth Israel Deaconess Medical Center, Boston, Massachusetts, UNITED STATES|E. Wachman, R. Iverson, Boston Medical Center, Boston, Massachusetts, UNITED STATES|D. Schiff, General Academic Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, UNITED STATES|L. Rhein, Neonatology/Pulmonology, University of Massachusetts, Worcester, Massachusetts, UNITED STATES|A. Picarillo, Maine Medical Center, Portland, Maine, UNITED STATES|H. Diop, D. Bercuvitz, Massachusetts Department of Public Health, Boston, Massachusetts, UNITED STATES

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