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Partnering with parents to improve outcomes for substance exposed newborns—a pilot program



Assess impact of parental involvement in care provision for term substance exposed newborns (SENs).

Study design

Prospective observational cohort study included mothers with opioid use disorder and their SENs over 4 year study period. Maternal–Infant dyads enrolled in EMPOWER and rooming-in (RI) programs were included and received care 24/7 in a private room until newborn’s discharge. Outcomes were compared for dyads participating in EMPOWER/RI with historical controls.


Ninety of 156 historical SENs were RI eligible, while 49 of 108 SENs born during RI period had mothers enrolled in EMPOWER. EMPOWER/RI SENs had lower rates for and duration of pharmacotherapy, shorter neonatal intensive care unit (NICU) and hospital lengths of stay. EMPOWER/RI increased initiation and continuation of breastfeeding at discharge.


Parental participation was associated with a decrease in initiation and duration of pharmacotherapy, NICU admission, length of stay and hospital charges while increasing breastfeeding initiation and continuation at discharge.

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Fig. 1: Rooming-In Policy.
Fig. 2: Baystate Medical Center’s Neonatal Opioid Withdrawal rooming-in agreement.
Fig. 3: Longitudinal Impact of EMPOWER and rooming-in programs on neonatal outcomes for eligible mother–infant dyads.


  1. 1.

    Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder doumented at delivery hospitalization – United States, 1999–2014. MMWR Morb Mortal Wkly Rep. 2018;67:845–9.

    Article  Google Scholar 

  2. 2.

    Patrick SW, Shumacher RE, Benneyworth BD, Kranz EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–9. JAMA. 2012;307:1934–40.

    CAS  Article  Google Scholar 

  3. 3.

    Kocherlakota P. Neonatal abstinence syndrome. Am Acad Pediatrics. 2014;134:e547–e561.

    Google Scholar 

  4. 4.

    Wachman EM, Warden AH, Thomas Z, Thomas-Lewis JA, Shrestha H, Nikita FN, et al. Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity. Drug Alcohol Depend. 2018;192:45–50.

    Article  Google Scholar 

  5. 5.

    Oei JL, Melhuish E, Uebel H, Azzam N, Breen C, Burns L, et al. Neonatal abstinence syndrome and high school performance. Pediatrics. 2017;139:e20162651.

    Article  Google Scholar 

  6. 6.

    Fill MMA, Miller AM, Wilkinson RH, Warren M, Dunn J, Schaffner W, et al. Educational disabilities among children born with neonatal abstinence syndrome. Pediatrics. 2018;142:e20180562.

    Article  Google Scholar 

  7. 7.

    Vela RM. The effect of severe stress on early brain development, attachment, and emotions: a psychoanatomical formulation. Psychiatr Clin North Am. 2014;37:519–34.

    Article  Google Scholar 

  8. 8.

    Abrahams RR, Kelly SA, Payne S, Thiessen PN, Mackintosh J, Janssen PA. Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Phys. 2007;53:1722–30.

    Google Scholar 

  9. 9.

    McCarthy JJ, Leamon MH, Finnegan LP, Fassbender C. Opioid dependence and pregnancy: minimizing stress on the fetal brain. Am J Obstet Gynecol. 2017;216:226–31.

    Article  Google Scholar 

  10. 10.

    Krans EE, Patrick SW. Opioid use disorder in pregnancy: health policy and practice in the midst of an epidemic. Obstet Gynecol. 2016;128:4–10.

    CAS  Article  Google Scholar 

  11. 11.

    Stone R. Pregnant women and substance use: fear, stigma, and barriers to care. Health Justice. 2015;3:2.12.

    Article  Google Scholar 

  12. 12.

    Lopian KM, Chebolu E, Kulak JA, Kahn LS, Blondell RD. A retrospective analysis of treatment and retention outcomes of pregnant and/or parenting women with opioid use disorder. J Subst Abus Treat. 2019;97:1–6.

    Article  Google Scholar 

  13. 13.

    Watson C, Mallory A, Crossland A. The spiritual and ethical implications of medication-assisted recovery in pregnancy: preserving the dignity and worth of mother and baby. Soc Work Christianity. 2019;46:66–86.

    Article  Google Scholar 

  14. 14.

    Krans EE, Bobby S, England M, Gedekoh RH, Chang JC, Maguire B, et al. The pregnancy recovery center: a women-centered treatment program for pregnant and postpartum women with opioid use disorder. Addict Behav 2018;86:124–9.

    Article  Google Scholar 

  15. 15. Accessed 23 Nov 2019.

  16. 16.

    Heijmans M, Waverijn G, Rademakers J, van der Vaart R, Rijken M. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Educ Couns. 2015;98:41–8.

    Article  Google Scholar 

  17. 17.

    Harrington KF, Zhang B, Magruder T, Bailey WC, Gerald LB. The impact of parent’s health literacy on pediatric asthma outcomes. Pediatr Allergy Immunol Pulmonol. 2015;28:20–6.

    Article  Google Scholar 

  18. 18.

    Kale MS, Federman AD, Krauskopf K, Wolf M, O’Conor R, Martynenko M, et al. The association of health literacy with illness and medication beliefs among patients with chronic obstructive pulmonary disease. PloS ONE. 2015;10:e0123937.

    Article  Google Scholar 

  19. 19.

    Devraj R, Borrego M, Vilay AM, Gordon EJ, Pailden J, Horowitz B. Relationship between health literacy and kidney function. Nephrology. 2015;20:360–7.

    Article  Google Scholar 

  20. 20.

    Holmes AV, Atwood EC, Whalen B, Beliveau J, Jarvis JD, Matulis JC, et al. Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics. 2016;137:e20152929.

    Article  Google Scholar 

  21. 21.

    McQueen KA. ‘Rooming-in’ could be an effective non-pharmacological treatment for infants with neonatal abstinence syndrome. Evid Based Nurs. 2018;21110.

  22. 22.

    Grossman MR, Berkwitt AK, Osborn RR, Xu Y, Esserman DA, Shapiro ED, et al. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics. 2017;139:e20163360.

    Article  Google Scholar 

  23. 23.

    Holmes AV. Rooming-in reduces costs of neonatal abstinence syndrome. Pharmacoecon Outcomes N. 2016;755:34–18.

    Article  Google Scholar 

  24. 24.

    Blount T, Painter A, Freeman E, Grossman M, Sutton AG. Reduction in length of stay and morphine use for NAS with the “eat, sleep, console” method. Hosp Pediatr. 2019;9:615–23.

    Article  Google Scholar 

  25. 25.

    Grisham LM, Stephen MM, Coykendall MR, Kane MF, Maurer JA, Bader MY. Eat, sleep, console approach: a family-centered model for the treatment of neonatal abstinence syndrome. Adv Neonatal Care. 2019;19:138–44.

    Article  Google Scholar 

  26. 26.

    Tilberg AD. Implementing the eat, sleep, console approach for NAS management: review of literature. Doctor of nursing practice (DNP) practice innovation projects. 125. 2019.

  27. 27.

    Minear S, Wachman EM. Management of newborns with prenatal opioid exposure: one institution’s journey. Clin Ther 2019;41:1663–8.

    Article  Google Scholar 

  28. 28.

    Jansson LM, Velez ML. Optimal care for NAS: are we moving in the wrong direction? Hosp Pediatr. 2019;9:655–8.

    Article  Google Scholar 

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The authors gratefully acknowledge the contributions of their subjects, and their subjects’ families, as well as those of their colleagues. In addition, we would like to acknowledge Dr Daniel Grow, Ms Annery Brown, Ms Linda Jablonski, Ms Nancy Rines, Ms Michelle Nicoli, Ms Sheila Foss, Ms Emily Lajeunesse, Ms Katiria Moran, Ms Sarah Crawford, Ms Donna Stafilarakis and entire OB nursing staff. Without their support the program could not have achieved the success it did.

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Correspondence to Rachana Singh.

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Singh, R., Rothstein, R., Ricci, K. et al. Partnering with parents to improve outcomes for substance exposed newborns—a pilot program. J Perinatol 40, 1041–1049 (2020).

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