The Tiniest Victims of the Opioid Crisis
By Tara Sundem, MS, APRN, NNP-BC, Co-Founder and Executive Director, Hushabye Nursery
Digital Exclusive - August 2022
Opioid Use Disorder (OUD) during pregnancy has been linked to serious negative health outcomes for pregnant women and their babies including preterm birth, stillbirth, maternal mortality, and Neonatal Abstinence Syndrome (NAS). According to the American Academy of Pediatrics, a baby is born every 15 minutes with NAS. The Arizona Department of Health Services reports that two babies are born each day with NAS. These numbers are growing.
In response to this community need, Hushabye Nursery opened its Center for Excellence including a 12-bed inpatient nursery to treat babies with NAS. Nationally, there are only two other similar facilities; however, neither also provides wrap-around, family-based services like Hushabye. Since its opening in November 2020, Hushabye Nursery has cared for 261 babies with NAS.
As a neonatal nurse practitioner, I witnessed firsthand in the NICU the extremely painful and complex withdrawal process of babies born dependent on the substances they were exposed to in the womb. The number of babies and families that we have served in just our first 17 months speaks to the veracity of the opioid crisis. It also means that there are many out there who still need us.
Hushabye Nursery’s mission is to embrace substance exposed infants and their caregivers with compassionate, evidence-based care that changes the course of their entire lives. Its vision is to reduce disparities in access to health services to improve the health and well-being of newborns who are suffering from opioid withdrawal, and their families who are suffering from opioid addiction. Family engagement and health equity are its two guiding principles.
Hushabye Nursery is a low-stimulation alternative to the bright lights and beeping monitors of the NICU that may not be conducive to baby’s withdrawal. Hushabye follows the evidence-based “Eat, Sleep, Console” (ESC) model that has been shown to significantly reduce the need for pharmacologic management of NAS and decrease length of stay without any noted adverse short-term outcomes.
Each baby with NAS has a private room that can be shared with mom (and dad). This promotes frequent feeding, continual one-on-one soothing, and the bonding that is critical for recovery and improved health outcomes. Family is involved in the baby’s treatment plan.
In its first year, Hushabye Nursery’s use of pharmacologic intervention was comparatively lower than in the NICU: Only 4% of the babies who came directly to Hushabye after birth required it. The average length of stay was seven days at Hushabye; the national average length of stay is 22 days at a hospital NICU. The average daily cost of treatment at Hushabye was $987, almost 70% less than the average daily cost of treatment at a hospital NICU. The financial savings to the healthcare industry could be substantial as a majority of Arizona newborns with NAS are insured by the Arizona Health Care Cost Containment System (AHCCCS).
Babies with NAS are particularly vulnerable to placement in foster care. Per the Children and Youth Services Review, “The opioid crisis in the U.S. is overwhelming the foster care system as states are experiencing a significant increase in the number of children being taken out of the custody of their parents or entering the welfare system with NAS. In addition, children removed because of parental drug use, the periods of time they spend in foster care are likely to be much longer and the removal is less likely to result in reunification.” Recognizing the negative Adverse Childhood Experiences (ACES) impact that foster care may have, Hushabye surrounds mom with resources and support to promote family cohesion at discharge. In 2021, 77% of mothers who were prenatally involved with Hushabye safely maintained custody of their infant.
Hushabye addresses the social determinants of health for the entire family, integrating healthcare and social services to help ensure babies are discharged to empowered, loving caregivers in a safe environment. Its intensive outpatient Hushabye Opioid Pregnancy Preparation and Empowerment program (HOPPE)®, created in 2017, has provided hundreds of parents with prenatal and postpartum trauma-informed education and training. Hushabye offers psychoeducation, counseling, recovery support, parenting and life skills education, individual service planning (case management), help in building social connections and peer support. Hushabye helps families navigate the health care maze alongside other critical systems; making phone calls with them to other service providers, advocating on their behalf and making warm handoffs.
About the Author:
Tara Sundem, MS, APRN, NNP-BC, has over 27 years of experience in Neonatal Nursing, the last 18 as a Neonatal Nurse Practitioner. Neonatal Abstinence Syndrome (NAS) is a primary focus for Tara. Her goal is to improve care for babies with NAS and their families. As Co-Founder of Hushabye Nursery, Tara has developed the HOPPE program (Hushabye Opioid Pregnancy Preparation and Empowerment) serving pregnant women with Opiate Use Disorder. If you need help or know someone who does, call/text 480-628-7500 or email Info@HushabyeNursery.org.