New Tool for Babies Exposed to Opioids – UWPRC Small Grants Projects

UWPRC staff met with Dr. Ann Allen, one of our 2020 Small Grants Recipients, to talk more about her project, Pilot Testing an Evidence-based, Family-Centered Intervention for Opioid Exposed Newborns in Wisconsin’s Rural and Community Hospitals.


The goal of this project is to develop and pilot an Eat, Sleep, Console (ESC) implementation intervention across Wisconsin community and rural hospitals by creating educational resources, and collaborating with the Wisconsin Association for Perinatal Care (WAPC) and Wisconsin Perinatal Quality Collaborative (WisPQC). ESC is an evidence-based treatment for newborns exposed to opioids, which affects nearly 1 in 100 Wisconsin newborns. By conducting this study, the team hopes to reduce unnecessary hospital days, healthcare costs and parent-child bonding disruption in Wisconsin infants exposed to opioids, and simultaneously generate the tools and preliminary data to support widespread implementation of ESC in states and health systems.

1. How would you explain this project to someone who is not familiar with it?

The project deals with neonatal abstinence syndrome (NAS) where babies are exposed to opioids in the uterus. The American Academy of Pediatrics recommends these babies be monitored, however, the tool that is traditionally used for monitoring lacks validity. It’s a catalog of various symptoms that the baby may have and requires you to disturb and un-swaddle the baby, which is counterintuitive. This has led to a lot of babies needing opioids (as a treatment for withdrawal symptoms due to in-utero opioid exposure) and a long hospital stay.

A few years ago, the New England Perinatal Quality Collaborative Network developed a new approach called Eat, Sleep, Console (ESC). Instead of using the old scoring tool, this approach focuses on seeing if the baby acts like we expect a newborn to act. For example, are they able to breastfeed or eat one ounce of formula? Are they able to sleep undisturbed for up to one hour? Are they able to be consoled within 10 minutes? If the answer is yes, then they are acting like a newborn should act and do not need any opioids. We also increase the mom’s role in this approach by empowering her to be at the bedside to feed and help console her baby.

Initial studies looking at this new approach have shown that it decreased the amount of opioids NAS infants were getting after birth (84% decrease in the number of babies exposed to opioids) and consequently, the length of their hospital stay was shorter as well (from 22.4 days to 5.9 days). Seeing this successful approach, we started using it at St. Mary’s in April 2019 and Meriter in 2020 with similarly successful results.

Figure 1. NAS rates in Wisconsin by county.

The rate of Wisconsin babies affected by prenatal opioid exposure is high and it’s even higher in some rural counties (Figure 1). We have a lot of resources at academic hospitals (like St. Mary’s and Meriter) but a lot of rural places don’t have the same resources needed to implement a new method of NAS assessment. It requires education of all medical providers (nurses, physicians, etc.), educational materials for parents, and other supports that some hospitals may not have the resources or bandwidth to provide.

To reach hospitals throughout the state, we partnered with the Wisconsin Association for Perinatal Care (WAPC) and the Wisconsin Perinatal Quality Collaborative (WisPQC). We will create a toolkit and educational materials for rural hospitals to use and implement ESC.

2. How is this work related to prevention or prevention research?

Figure 2. NAS rates in the US by state.

Opioid exposure is a public health crisis in the United States as well as in Wisconsin (Figure 2). The rates of opioid exposure in infants have increased five-fold over the past 15 years and rural communities tend to bear a large part of this burden. This is made worse by the fact that many rural and community hospitals throughout the state lack the resources that they might need to implement a more effective strategy like ESC.

Our work in this project focuses on optimizing family-centered care for infants and mothers in hospitals throughout Wisconsin. When implemented, ESC will prevent unnecessary exposure to opioids after babies with NAS are born and subsequently reduce their hospital stay.

3. What has the role of your community partners been?

WAPC and WisPQC have recently been focusing on NAS as one of their initiatives, which is a great way to reach partners at a lot of community and rural hospitals. Their main role has been to connect us to hospitals and help disseminate the toolkits and educational materials.

4. What stage is the project on and what are some next steps?

We started the project in March 2021 and we expect it to take 12 months to complete. So far we have identified many community and rural hospitals who are interested in our resources. These hospitals have started collecting baseline data before implementing the program so that we can compare its impact in the future. The Co-Principal Investigators and I are creating the toolkits and workshop materials and our next step will be to disseminate them.

We will be looking for federal funding for statewide and national dissemination. There is a lot of demand for implementing ESC both in the Midwest and elsewhere so we would like to expand our efforts geographically.