Neonatal Abstinence Syndrome: Assessing Practice and Challenges in Vermont Hospitals

Background: Neonatal abstinence syndrome (NAS), characterized by tremors, vomiting, diarrhea, fever, diaphoresis, irritability, high-pitched cry and tachypnea, affects some newborns with prenatal opioid exposure. In 2018, the rate of opioid use amongst Vermont’s pregnant women was reported highest in the nation, with a rate of infants developing NAS significantly higher than the national average. Purpose: This project assessedthe use and impact of evidence-based best practice when caring for infants with NAS in Vermont’s birth hospitals. These included utilization of the Eat, Sleep, Console model, non-pharmaceutical interventions, and volunteer cuddler programs. Methods: This project adopted a mixed method approach, using internet-based surveys, retrospective chart reviews, and semi-structured interviews to collect data from Vermont birth hospitals. Results: Ten birth hospitals participated in the project, with nine reporting current use of the ESC model. Four birth hospitals reported using volunteer cuddler programs in the care of infants with NAS. Collaborative decision-making, engagement and empowerment of the family, a need for leadership and ongoing training, nurse autonomy, patient-centered care, family concern about stigma, and staffing issues were common qualitative themes identified through the semi-structured interviews. Conclusion: The ESC model has been both widely adopted and well-received in birth hospitals in Vermont. Increased use of volunteer cuddler programs will require systems that address barriers to implementation and minimize the burden on staff. The identification of common experiences, needs, and challenges amongst Vermont birth hospitals presents opportunities for collaboration and knowledge-sharing in improving the care of infants with NAS and their families