Effective Caregiving for Neonatal Abstinence Syndrome: Development of an Instructional Mobile Technology Platform for High-Risk Pregnant Women

ABSTRACT
Due to an alarming rise in opioid use among the general population that is mirrored in pregnant women, Neonatal
Abstinence Syndrome (NAS) rates have increased in the US from 2004 to 2014. Most newborns experiencing
NAS require non-pharmacologic care, which entails, most importantly, maternal involvement with her newborn.
Facilitating postpartum maternal-newborn involvement is critical in preventing further adverse maternal-newborn
outcomes. To achieve positive maternal-newborn involvement, mothers need to learn effective caregiving NAS
strategies while they are pregnant. Surprisingly, current obstetrical practice standards for high risk pregnant
women do not address this pressing need, in part because no interventions exist to prepare future mothers for
the challenges of caring for their newborns at risk for NAS. To address this critical gap, I propose to adapt an
existing mobile NAS tool for clinician training and decision support, for high-risk pregnant women and assess its
usability, acceptability, and feasibility in a small randomized controlled analog trial. First, I will conduct semi-
structured interviews with a panel of neonatology experts, NAS care providers, and mothers with NAS-affected
babies to gather their recommendations on management of NAS and explore their perspectives on the care of
these newborns. Findings will guide the adaptation of the existing mobile NAS tool for high-risk pregnant women.
I will then test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant
women receiving opioid agonist therapy (OAT) at Spokane Regional Health District’s Opioid Treatment Program
and Evergreen Recovery Center. Finally, we will randomize 30 high-risk pregnant women seen at these facilities
to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these mothers on
maternal drug relapse and OAT continuation, maternal-newborn bonding, length of newborn hospital stays,
readmissions rates, breastfeeding initiation and duration, and postpartum depression and anxiety at 4, 8, and 12
weeks postpartum. Findings will serve as pilot data for a subsequent large R01 randomized controlled analog
trial testing the efficacy of the adapted NAS caregiving tool in reducing poor outcomes for NAS-affected
newborns and their mothers. My proposed research plan integrates activities, formal training, and mentorship
from experts (Drs. Sterling McPherson, Hendree Jones, John Roll, Celestina Barbosa-Leiker, and Kim Johnson)
in development, testing and implementation of substance use disorder treatment for perinatal women, mobile
health interventions, and implementation of clinical trials in perinatal women with substance use disorders. This
Mentored Research Scientist Development Award (K01) will build upon my previous training and allow me to
pursue my long-term career goal of becoming an independent investigator with an established program of
research focused on the development, implementation, and testing of interventions for substance using perinatal
women and reduction of poor health outcomes for substance using perinatal women and their newborns.

Grant Number: 5K01DA051780-05
NIH Institute/Center: NIH
Principal Investigator: Ekaterina Burduli