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[Phoebe] Hi and welcome to Beyond the Data.
I'm Dr. Phoebe Thorpe and here
with me today is rear Admiral Wanda Barfield, the director
of the Division of Reproductive Health here at CDC.
Wanda, thank you so much for joining us.
[Wanda] Thank you, Phoebe.
[Phoebe] Your session that from two years ago
about neonatal abstinence will be running.
Part of the reason we're rerunning it is
because the opioid epidemic continues
to worsen in the United States.
What is neonatal abstinence?
[Wanda] So, um, it, it's great
that we're doing another opportunity to talk
about Beyond the Data here.
Neonatal Abstinence Syndrome is something
that I know very personally in addition
to directing the division of reproductive health,
I'm also a neonatologist, which is a specialist in pediatrics
that focuses on the care of critically ill newborns.
Neonatal Abstinence Syndrome is a withdrawal syndrome
that occurs for babies who've been exposed
to opioids during pregnancy.
Now, this may occur under a variety of circumstances,
but the challenge here has been more recently we've seen it
as a result of the opioid crisis.
So Neonatal Abstinence Syndrome can occur when those withdrawal
that a pregnant woman has after her baby is born
and that baby has been exposed
to either prescription substances
that include subsistence's, like Vicodin, OxyContin,
or it can be illicit substances that can also include heroin.
Or it can be exposure to medication assisted treatment
such as Buprenorphine or Methadone.
And these infants have symptoms that occur about 48 to 72 hours
after birth and these symptoms are fairly distressing.
They include things
like excessive crying, inconsolability.
They may have difficulty feeding;
they may have watery stools or diarrhea.
They may also, um, have seizures and so these particular symptoms
and signs need to be treated and they need
to be treated in a gradual method.
[Phoebe] So when these newborns have the Neonatal Abstinence
Syndrome and are going through withdrawal what,
what needs to be done to treat them.
[Wanda] So the treatment can be somewhat complicated
and protracted.
So these infants need time in terms of a gentle weaning
from these medications.
And so as a result, they're given medications
so that they can reduce these symptoms that we're seeing
when they're initially having withdrawal symptoms.
Most infants may show signs of withdrawal anywhere between 48
to 72 hours after birth.
Because it takes time for these infants to recover,
it means that they need close and careful monitoring
in either a newborn intensive care unit
or they may need very close monitoring
in a special care nursery.
And so as a result, that means they've got prolonged
hospitalization and as you know, that can be expensive.
They also need to be closely monitored for these signs
and symptoms that could potentially get them
into a lot of trouble.
We know that in the United States, in fact, that the cost
of Neonatal Abstinence Syndrome is about 2.5 billion dollars
with the major burden being born by Medicaid
at about $2 billion dollars.
[Phoebe] Each year.
[Wanda] Each year.
[Phoebe] Wow.
What, what are we doing?
So I would imagine that if you, um, the increase use
of opioids while use and abuse of opioids in women
who are pregnant is part of the reason
that the Neonatal Abstinence Syndrome is going up.
What are some of the important things to help the moms, uh,
with the women who are pregnant
to prevent Neonatal Abstinence Syndrome?
[Wanda] Yes.
Phoebe, you bring up an important point.
It's important to note that we, we coined the issue
of Neonatal Abstinence Syndrome
as really the tip of the iceberg.
This is really sort of the final result
of a much more complicated issue and for every baby that we see
with Neonatal Abstinence Syndrome, there's a mom who's
in great need of support.
But it goes beyond that.
This is really a life course issue and we really need
to think not only of the care and concern of the baby,
but the care and concern for mothers and even
for women prior to pregnancy.
You know, many women may not even know
that they're pregnant during the time
that they may be using a prescription drug
and as a result, they then may find themselves pregnant
and treatment during that time maybe more challenging.
However, there is an opportunity for us
to better monitor pregnancies and help women
with medication-assisted therapy.
[Phoebe] Yeah.
You bring up a point that, that was one
of the things I was going to ask about and it came
out in a session about medication, medicated,
medication assisted therapy.
What? What is that and how, what, what is being done
to help women during their pregnancy?
[Wanda] So medication assisted therapy is an opportunity
to treat women during pregnancy,
but so that they can also be monitored in terms of the use
of these substances that include either Methadone
or Buprenorphine.
And it also allows an opportunity to not only monitor
that woman during her pregnancy,
but to help to identify an infant
who may potentially have Neonatal Abstinence Syndrome.
However, it may be a much more controlled path rather than sort
of a quick withdrawal.
[Phoebe] Yeah, so it's very important to,
to try to get the women that the treatment they need while
they're pregnant.
[Wanda] Yes.
And I've had opportunities to, you know, talk with women
and talk with families who may be
on medication assisted therapy and what they might anticipate
in terms of the days of, you know, during delivery
in those subsequent days following delivery.
And I think that's a really helpful approach.
[Phoebe] What else needs to be done to reduce
or prevent Neonatal Abstinence Syndrome in the United States?
[Wanda] So when we were thinking about prevention, again,
you know, that's an important role that CDC plays
in terms of prevention.
More broadly we're really looking
at how we can collectively as an agency address the opioid crisis
and that's really through our combined efforts.
So just thinking about what we can do at CDC here,
we are really focusing on work collectively.
As you know, CDC has produced a lot of information
about appropriate prescribing and so CDC has guidelines
on appropriate prescribing guidelines for physicians
and that's a very important component that we need
to disseminate and help educate providers.
You know, the other component is surveillance.
It is so important, not only that we have good
and accurate surveillance, but that it's as rapid as possible.
And CDC is really working toward making the data available much
more rapidly.
Whether that's, you know, and this is more broadly,
I'm not just talking about Neonatal Abstinence Syndrome,
but you know, what can we do in terms of addiction,
emergency room, um, related issues, um,
the unfortunate event of overdose.
So how can we get that information out more quickly
so that people can respond?
For states, there's a lot of exciting work that's going
on in the area of what's called perinatal quality collaboratives
and these are teams of healthcare providers as well
as public health providers that are working together to think
about evidence based interventions
to really improve the care of infants
with Neonatal Abstinence Syndrome as well
as improving the care for mothers.
So specifically for example, the challenge that we have now is
that our treatment protocols are still somewhat subjective
when we're trying to treat infants with NES,
but in the context of a quality improvement framework,
we might be able to do a more standardized, regimented process
of identifying infants at risk, appropriately treating them
and then perhaps reducing those hospital lengths
of stay for those newborns.
There's also better techniques, for example, promoting um,
maternal infant bonding
and promoting breastfeeding is also a good way
to help reduce the length of stay for newborns with regard
to Neonatal Abstinence Syndrome.
[Phoebe] So what I hear is surveillance
so they can help figure out where the problem is.
[Wanda] Yes.
[Phoebe] And then also quality improvement so that they,
the solutions that we offer are better too.
And combining those to, make it better.
[Wanda] Yes.
[Phoebe] Um,prevention..If other people are interested
in knowing more about clinicians or others about, uh,
the opioid use, misuse or NAS, where can they find that?
[Wanda] Well, there are several resources.
So first for providers there, there's great opportunity
through the CDC guidelines in terms of prescribing practices,
but there's also clinical groups that are very helpful.
For example, the American Academy
of Pediatrics has guidance on the care of infants
with Neonatal Abstinence Syndrome as well
as the American Association of Obstetricians and Gynecologists
or the American College of Obstetricians and Gynecologists
and they have guidances for the treatment
of women during pregnancy.
[Phoebe] Thank you so much for joining us.
This is such an important topic and it's like you said,
it's the tip of the iceberg and so it isn't always seen well.
I really appreciate your efforts to make it better now and,
and to help these children.
[Wanda] Well thank you too Phoebe
for raising this important issue.
[Phoebe] And thank you for joining us for Beyond the Data.
We'll see you next time.
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