{"id":31775,"date":"2020-07-02T20:53:20","date_gmt":"2020-07-02T20:53:20","guid":{"rendered":"https:\/\/caseyfamilyv2.wpengine.com\/eat-sleep-console\/"},"modified":"2026-08-05T15:28:55","modified_gmt":"2026-08-05T15:28:55","slug":"eat-sleep-console","status":"publish","type":"post","link":"https:\/\/www.casey.org\/es\/eat-sleep-console\/","title":{"rendered":"\u00bfQu\u00e9 pueden aprender las agencias de protecci\u00f3n infantil de la respuesta del Hospital Infantil Yale New Haven a los beb\u00e9s con s\u00edndrome de abstinencia neonatal?"},"content":{"rendered":"
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Summary<\/h3>\n

New protocols for treating infants with Neonatal Abstinence Syndrome result in better health outcomes, lower costs, and fewer family separations.<\/em><\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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In Connecticut, one hospital\u2019s willingness to rethink the traditional approach to treating infants born with Neonatal Abstinence Syndrome (NAS) has resulted in markedly better outcomes, including shorter hospital stays, decreased use of morphine, and lower treatment costs.1<\/sup><\/a> The state\u2019s Department of Children and Families (DCF) enthusiastically supports the Yale New Haven Children\u2019s Hospital (Yale) new protocols, which align well with a DCF and Yale School of Medicine treatment model, Family-Based Recovery (FBR)<\/span><\/a>. Both institutions have left behind approaches rooted in tradition rather than evidence, and turned in favor of new strategies that aim to promote healthy parent-child attachment, destigmatize substance use disorders, and prevent unnecessary interventions.<\/p>\n

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DCF has reported that thanks to Yale\u2019s new approach, caseworkers are able to engage more easily with families impacted by NAS and parental substance use while they are in the hospital. Specifically, DCF reported that the agency is removing fewer infants from their mothers, and that staff are able to more easily assess, observe, and create safety plans for families when they are readily able to see interactions between the mother and baby, and have access to health and care information.<\/b><\/span>2<\/sup><\/a><\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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The natural state of pediatric nurses and staff is empathy. It makes everybody feel better when you support and empower parents, and it\u2019s easier for the staff<\/p>\n<\/blockquote>\n

— Dr. Matthew Grossman, Yale New Haven Children\u2019s Hospital<\/cite><\/figcaption>\n <\/div>\n\n <\/div>\n<\/figure>\n\n\n
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Under Yale\u2019s approach to care, even in instances where the mother is unable to provide for the infant\u2019s needs or must complete inpatient treatment after discharge, she has an opportunity to bond with her baby during its first few days of life. Research shows that the parent-child relationship may be a strong motivating factor for parents in substance use treatment, and this bonding time may increase the chances of future reunification<\/b><\/span>.3<\/sup><\/a> The new approach, and the path Yale took to develop it, offer insights for child protection leaders that may help to further transform the experience of infants born with NAS and their families.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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Initial Resistance from Nursery Staff<\/h3>\n

The decision to pull infants with NAS from the NICU and place them in traditional rooms with their mothers was not initially popular with nursery staff. It took 18 months of negotiating before staff began placing babies with their mothers outside of the NICU. Even then, nursery staff found \u201cmedical problems\u201d (usually problems that could be resolved in minutes) that sent infants with NAS back to the NICU. However, after about a year, and with evidence that the new approach worked for both babies and mothers, nursery staff stopped transferring infants back to the NICU and began supporting the new model.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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The traditional standard of care for NAS<\/h2>\n \n \n \n

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NAS occurs when a fetus is exposed to prolonged periods of parental opioid use; once born, the infant\u2019s body is physically addicted to the drug and the infant experiences withdrawal symptoms.4<\/sup><\/a> Based on national data collected from neonatal intensive care units (NICUs), the rate of infants diagnosed with NAS has grown exponentially in recent years, increasing by more than 400% from 2004 to 2014<\/span><\/a>, from 1.5 to 8.0 per 1,000 hospital births.<\/p>\n

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Despite this rapid increase in cases, the standard approach to NAS care in most hospitals has not changed significantly since the 1980s. It involves removing infants from their mothers\u2019 care, placing them in the NICU, suppressing withdrawal symptoms with medication (usually morphine), using a complex scoring tool to assess symptoms at regular intervals, and weaning infants from medication on strict dosing schedules.<\/p>\n

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When Yale\u2019s team began to question the traditional approach, they were surprised to discover that very little evidence supported it. The approach was costly, outcomes were generally poor and, despite the standardized model, there was substantial variation in the length of stay for infants with NAS across hospitals. In addition, the standard of placing infants in the NICU was based on one article from the 1970s that pertained only to infants who had experienced seizures. The Finnegan Neonatal Abstinence Scoring System, a 21-item scale commonly used to determine an NAS infant\u2019s course of treatment, never had been properly evaluated despite being widely employed for more than 30 years.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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It became clear that there was absolutely no real evidence behind what we were doing \u2014 we were just doing it because it was what we had always done. We took babies having a tough time, and separated them from their moms. We had moms going through tough times, and we separated them from their newborns. And then we were leaving the babies in a box and treating them with morphine. But we found out that if we treated them like babies, they responded like babies. And they got better, faster.<\/p>\n<\/blockquote>\n

— Dr. Matthew Grossman, Yale New Haven Children\u2019s Hospital<\/cite><\/figcaption>\n <\/div>\n\n <\/div>\n<\/figure>\n\n\n
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Child protection involvement for these infants is also common. In some cases, this is due to concomitant abuse or neglect. Often, however, hospital staff believe they should (and some states are legally required to) report the family to CPS because the infant was born substance exposed, even if the mother\u2019s substance use disorder is well managed and no signs of maltreatment are present.5<\/sup><\/a><\/p>\n

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Both the traditional approach to medical care, and inflexible or broadly interpreted CPS reporting guidelines, can result in interventions that create additional stress for new families. In some cases, they can result in unnecessary separation of vulnerable infants from their parents at a critical point in their development.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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Questions for child protection leaders to consider<\/h3>\n