What approaches and interventions work best for babies exposed to opioids in the womb focus of IU research
Babies born to women who use opioids during pregnancy can suffer from withdrawal symptoms at birth in addition to developmental and behavioral problems later in life. The diagnosis associated with these problems, neonatal abstinence syndrome, has been on the rise in central Indiana.
A range of interventions are used to help babies born to addicted mothers, but little is known about which approaches result in better outcomes.
Sarah Wiehe's project for IU's Responding to the Addictions Crisis Grand Challenge will use more than a decade of data from numerous sources to determine which factors and interventions lead to the best outcomes for these children. Additionally, Weihe, associate professor of pediatrics at the IU School of Medicine, will assess the effectiveness of the new CARE Plus program, which is designed to help pregnant women overcome opioid addiction and is also funded through the IU Grand Challenges initiative.
The first hurdle to overcome in conducting the research is the difficulty of identifying babies who were exposed to opioids in the womb. In addition to the infants receiving a neonatal abstinence syndrome diagnosis, some babies are born to addicted mothers whose drug use is not detected. Moreover, the criteria for diagnosing neonatal abstinence syndrome — such as fidgeting, irritability, and sleep problems — are subject to interpretation.
If an infant's symptoms are perceived as mild, the baby may not receive a diagnosis, even if he or she was exposed to opioids. Because infants' health records are not linked to those of their parents, determining exposure from medical records is a challenge.
Wiehe will provide these linkages by piecing together data collected by criminal and juvenile justice agencies, emergency medical services, hospitals and government service providers to determine exposure and look for patterns in which types of interventions, before or after the baby’s birth, are associated with better health and wellbeing over time. (All data is privacy protected and individual identities are not disclosed.)
One particular question is how treatment for neonatal abstinence syndrome affects a baby’s outcomes. The standard treatment involves 4 to 6 weeks of care in a hospital’s neonatal intensive care unit, during which the infant receives an initial dosage of morphine that is gradually reduced until the treatment can be stopped without causing the baby to experience withdrawal.
To avoid administering these drugs to infants, some hospitals will first attempt to ease withdrawal symptoms through alternative measures like skin-to-skin contact with the mother, swaddling and a darkened, quiet environment. Although this approach results in families being discharged from the hospital sooner, it is not clear whether babies and families who receive the alternative treatment have better results over time.
Wiehe's work will seek to answer this question in addition to assessing how the provision of social services (such as Section 8 housing, daycare vouchers and food assistance) relate to outcomes.
While the investigations described above are driven by backward-looking data, the CARE Plus program offers an unprecedented opportunity to follow a cohort of mothers who are recruited during pregnancy and receive support through the first year after their babies' births. Combining the CARE Plus evaluation with the larger data analysis will allow Weihe's team to develop recommendations for best practices and policies to protect the next generation from enduring effects of today's opioid crisis.