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Colorado Hospitals Use New Approach To Treat Opioid-Exposed Newborns

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Dr. Sunah Hwang presents at the CHoSEN Collaborative Fall Forum in Glenwood Springs, Colorado. The collaborative was created to improve outcomes for infants prenatally exposed to drugs.

There is a traditional treatment for babies experiencing withdrawal from opioids: newborns are separated from their mothers and taken to the neonatal intensive care unit to receive tapered doses of morphine or methadone. They can stay in the hospital for weeks.

A Colorado-based collaborative is changing this approach.

In 2017 the Colorado Hospital Substance Exposed Newborns Collaborative (CHoSEN Collaborative) was created to improve outcomes for infants prenatally exposed to drugs. The approach allows mothers to stay with and soothe their babies while withdrawal medications are used sparingly.

"Moms and babies are rooming in and staying together in the nursery. We've also moved away from treating as much as we had previously with a medication like morphine and methadone," said Dr. Sunah Hwang, the collaborative's lead physician and a neonatologist at Children's Hospital Colorado and University Hospital.

The collaborative includes nearly 25 hospitals mainly in Colorado, as well as Wyoming and Montana.

When the program started, nearly 70% of opioid-exposed newborns were treated with medication. The rate has since declined to less than 10%. The average length of hospital stays also decreased from more than two weeks to six days.

In Colorado, nearly 50% of births occur in a hospital participating in this quality improvement collaborative, according to a press release. From 2011 to 2016, reported cases of Neonatal Abstinence Syndrome (NAS) in Colorado increased 120% based on hospital discharge coding data.

But the collaborative found that incidents of prenatal opioid exposure in newborns was much higher than what had been publicly reported by the Colorado Department of Public Health and Environment or Medicaid offices.

The increase, said Hwang, is due to more accurate and consistent reporting of NAS cases by hospitals through the CHoSEN data system instead of relying on hospital billing codes to identify fetal exposure.

The collaborative provides resources to participating hospitals, including training on behavioral techniques to soothe babies in withdrawal as an alternative to prescribing opiates, tools to create safe discharge plans and guidelines for safe breastfeeding for moms impacted by drug use, especially opioids.

CHoSEN has seen short-term results, mainly cost savings to the hospitals. Hwang said it's not clear if these expenses are being absorbed by other health care systems, like community providers or pediatricians who treat the babies after they are discharged.

But qualitative interviews with families and staff have been positive.

"Nearly universally we're hearing that families feel more engaged because they're considered the first line of therapy," Hwang said. "Really parental engagement is one of the biggest significant changes that this new care paradigm adopts."

Editor's Note: This story has been updated to clarify that babies can be born experiencing withdrawal from opioids, not addicted to opioids.

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