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Shifting the care paradigm for opioid-exposed newborns in Southern Colorado

Journal of Perinatology volume 41, pages 1372–1380 (2021)Cite this article

Subjects

Abstract

Objective

Compare Eat, Sleep, Console (ESC) and limited opioid treatment on birth length of stay (LOS), postnatal opioid exposure, and 30-day re-hospitalizations in opioid-exposed newborns (OENs) in two hospital systems.

Study design

Quality improvement teams supported change from scheduled methadone using Finnegan scores to standardized non-pharmacologic support using ESC. Intermittent morphine was used only if needed. Statistical process control charts examined changes over time.

Result

Between 2017 and 2019 we treated 280 OENs ≥35 weeks’ gestation, 101 and 179 per hospital. Post-ESC, LOS decreased 51.2% (16.8–8.2 days), postnatal opioid treatment decreased from 64.1 to 29.9%; percent decline in both hospitals was similar. 30-day re-hospitalizations were 5/103 (4.8%) pre-ESC, and 7/177 (4.0%) post-ESC (p = 0.72, NS). Multiple substance co-exposures were common (226/280, 80.7%).

Conclusion

ESC and as needed morphine decreased LOS and postnatal opioid exposure for OENs in two hospital systems without increasing 30-day readmissions. ESC appears effective in OENs with multiple co-exposures.

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Fig. 1: Process control chart of average length of stay for OEN by quarter of birth.
Fig. 2: Length of pharmacologic treatment with opioids, total cohort.

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Acknowledgements

We would like to thank the staff and providers at both hospitals for their enthusiastic support of the project and excellent patient care, and the QI teams for their leadership, particularly Victoria Del Valle, RNC, CNS at Memorial and Stephanie Shaver, RNC at Parkview for their work on project implementation.

Funding

University of Colorado School of Medicine Upper Payment Limit Program; Custodial Funds from the Colorado Attorney General’s Office; The COPIC Foundation; The Caring for Colorado Foundation.

Author information

Authors and Affiliations

  1. Pediatrix Medical Group, Colorado, CO, USA

    Susan F. Townsend & Camille D. Hodapp

  2. Neonatology, UCHealth Memorial Hospital, Colorado Springs, CO, USA

    Susan F. Townsend

  3. Neonatology, Parkview Medical Center, Pueblo, CO, USA

    Susan F. Townsend & Camille D. Hodapp

  4. Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Susan F. Townsend, Blair Weikel & Sunah S. Hwang

  5. Colorado Perinatal Care Quality Collaborative, Colorado, CO, USA

    Sunah S. Hwang

Authors
  1. Susan F. Townsend
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  2. Camille D. Hodapp
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  3. Blair Weikel
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  4. Sunah S. Hwang
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Contributions

SFT conceptualized and designed the study, analyzed and interpreted data, drafted the initial manuscript, and approved the final manuscript as submitted. CDH conceptualized and designed the study, analyzed and interpreted data, critically reviewed and edited the manuscript, and approved the final manuscript as submitted. BW carried out the analysis, interpreted the data, critically reviewed and edited the manuscript, and approved the final manuscript as submitted. SSH conceptualized and designed the study, supervised the data analysis and interpreted data, critically reviewed and edited the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Susan F. Townsend.

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Conflict of interest

The authors declare no competing financial interests or conflicts of interest. The Colorado Multiple Institutions Review Board (COMIRB) reviewed the study, and approved as exempt as a QI project. The study was performed in accordance with the Declaration of Helsinki.

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Townsend, S.F., Hodapp, C.D., Weikel, B. et al. Shifting the care paradigm for opioid-exposed newborns in Southern Colorado. J Perinatol 41, 1372–1380 (2021). https://doi.org/10.1038/s41372-020-00900-y

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