Minnesota hospitals and health systems have come together to develop new ways to better screen for and treat pregnant women and their newborn babies who are addicted to opioids.

Neonatal abstinence syndrome, or NAS, is drug withdrawal that occurs in newborns who were exposed to opioids prior to birth. NAS is on the rise in Minnesota and nationwide.

• A study published in December 2016 in the medical journal JAMA Pediatrics found that the number of infants born affected by opioids rose dramatically from 2004 to 2013, especially in rural areas. Rural areas saw an increase in NAS, going from 1.2 NAS cases per 1,000 hospital births in 2004 to 7.5 per 1,000 in 2013. Urban areas saw a slower increase, going from 1.2 NAS cases per 1,000 hospital births in 2004 to 4.8 per 1,000 in 2013.
• An August 2016 report from the Centers for Disease Control and Prevention (CDC) also found that the number of opioid-addicted babies being born nationwide has tripled over the past 15 years – and suggested that this finding likely underestimates the true problem. NAS increased 300 percent between 1999 and 2013, from 1.5 cases per 1,000 hospital births to 6 per 1,000.
• An analysis of Medicaid data released in September 2015 by the Minnesota Department of Human Services showed that from 2009 to 2012, both maternal opioid abuse diagnoses and infant NAS diagnoses almost doubled.

Sanford Bemidji Medical Center in northern Minnesota has been leading the way in the state when it comes to treating opioid addiction in pregnant women and the subsequent dependency of their newborn children. When hospital staff began to notice an increasingly common trend of substance abuse – specifically opiate use – among the pregnant women coming in to deliver, leadership looked to community partners to help. Sanford Bemidji began collaborating with Beltrami County Health and Human Services and Red Lake Family & Children’s Services in 2014 and secured more than $1.6 million in grant funding from PrimeWest Health’s Community Reinvestment Grant Program to reduce prenatal substance abuse in Beltrami, Clearwater and Hubbard counties.

“Statistics from 2009 to 2012 showed nearly double the instances of maternal opioid abuse diagnoses and infant NAS in Minnesota, so we saw a need in our community to provide more education and resources for maternal substance abuse to help women lead healthier pregnancies,” said Lisa Johnson, BSN, RN, director of women’s and children’s services at Sanford Health of Northern Minnesota.

Together, the collaboration created the First Steps to Healthy Babies program, which offers education and intervention for substance abuse during pregnancy. The program aims to connect women with services and resources to treat the addiction, break dependence on alcohol or drugs and help women with prenatal care.

To help provide a statewide response to the opioid epidemic in pregnant women and newborns, the Minnesota Hospital Association (MHA) convened a work group of obstetricians, perinatalogists and neonatologists to develop tools that hospitals and health systems across the state can now use to identify, assess and treat newborns with NAS and their mothers experiencing opioid addiction.

“We are in the midst of a severe opioid epidemic and many of our hospitals and health systems are caring for women who are addicted to these powerful opioids during their pregnancy and for babies who are born addicted,” said Dr. Rahul Koranne, MHA’s chief medical officer. “Our care teams want to treat addiction as early as possible in the course of a woman’s pregnancy in order to ensure a healthy mom and baby.”

Resources include a risk assessment tool to help medical professionals identify opioid addiction early during pregnancy, so pregnant women can get appropriate treatment before giving birth; several different newborn assessment tools to help medical professionals identify NAS; and information about NAS treatment options to help hospitals and health systems make decisions about how they will treat NAS. View the toolkit and additional resources.

“Through the First Steps to Healthy Babies program, we have established the groundwork for mothers to have a safe and healthy pregnancy by encouraging a sober lifestyle as we work to end prenatal substance abuse,” said Johnson. “While the addition of the NAS toolkit has validated many of our existing approaches in management of NAS, it has also given us information to update policies, procedures and processes. By providing Minnesota hospitals with a foundation to identify, intervene and manage mothers and infants exposed to substances during pregnancy, we can work together to improve care and outcomes.”

The Minnesota Hospital Association represents 142 hospitals and health systems, which provide quality care for their patients and meet the needs of their communities.

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