A rooming-in program to mitigate the need to treat for opiate withdrawal in the newborn.

OBJECTIVE: The purpose of this study was to explore the effect of our rooming-in protocol on the need to treat withdrawal in the opiate-exposed newborn. METHODS: We reviewed the medical records of mother-infant dyads born between October 1, 2003, and December 31, 2006, who received care in our rooming-in program. Data on the type of drug used by the mother, maternal methadone dose at delivery, morphine treatment of the baby, and perinatal outcome were considered. RESULTS: We found a significant positive relationship between maternal methadone dose at delivery, "other opiate" use, and breastfeeding and the need to treat the neonate for withdrawal. We also found the maternal methadone dose at delivery to be related to the duration of pharmacological treatment of the neonate. CONCLUSION: Our findings suggest a role for our rooming-in program in mitigating the relationship between maternal methadone dosage and the need to treat opiate withdrawal in the newborn. Consideration of the role played by the mother-infant dyad model of care needs to be considered in future studies.

An evaluation of rooming-in among substance-exposed newborns in British Columbia.

OBJECTIVE: Rooming-in, the practice of caring for mother and newborn together in the same room immediately from birth, is preferred for the general postpartum population but is not yet standard practice of care for newborns of substance-using women. Such newborns are usually separated from their mothers and admitted to a neonatal intensive care unit and treated for substance withdrawal if necessary. We compared clinical and psychosocial outcomes associated with traditional standard care models versus an interdisciplinary rooming-in model of care for substance-exposed newborns. METHODS: We conducted a retrospective comparative review of a cohort of substance-exposed newborns. Data were extracted from the British Columbia Perinatal Health Program database to populate the standard care and rooming-in groups. The main study outcomes were neonatal admission to NICU, breastfeeding, presence of neonatal withdrawal, length of stay, and custody status at discharge. RESULTS: Rooming-in was associated with a significant decrease in admissions to NICU and a shorter NICU length of stay for term infants, increased likelihood of breastfeeding (either exclusively or in combination with formula) during the hospital stay, and increased odds of the baby being discharged home with the mother. There were no significant differences between groups with respect to the presence of neonatal substance withdrawal or breastfeeding status at discharge. CONCLUSION: Rooming-in may facilitate a smooth transition to extrauterine life for substance-exposed newborns by decreasing NICU admissions and NICU length of stay for term infants, encouraging breastfeeding, and increasing maternal custody of infants at discharge. This review supports the finding that rooming-in is both safe and beneficial for substance-exposed babies.

Rooming-in compared with standard care for newborns of mothers using methadone or heroin.

OBJECTIVE: To evaluate the effect of rooming-in (rather than standard nursery care) on the incidence and severity of neonatal abstinence syndrome among opioid-exposed newborns and on the proportion of mothers who retain custody of their babies at hospital discharge. DESIGN: Retrospective cohort study. SETTING: Lower mainland in southwestern British Columbia. PARTICIPANTS: We selected 32 women in the city of Vancouver known to have used heroin or methadone during pregnancy between October 2001 and December 2002. Comparison groups were a historical cohort of 38 women in Vancouver and a concurrent cohort of 36 women cared for in a neighbouring community hospital. MAIN OUTCOME MEASURES: Need for treatment with morphine, number of days of treatment with morphine, and whether babies were discharged in the custody of their mothers. RESULTS: Rooming-in was associated with a significant decrease in need for treatment of neonatal abstinence syndrome compared with the historical cohort (adjusted relative risk [RR] 0.40, 95% confidence interval [CI] 0.20 to 0.78) and the concurrent cohort (adjusted RR 0.39, 95% CI 0.20 to 0.75). Rooming-in was also associated with shorter newborn length of stay in hospital compared with both comparison groups. Newborns who roomed in at BC Women's Hospital were significantly more likely to be discharged in the custody of their mothers than babies in the historical cohort (RR 2.23, 95% CI 1.43 to 3.98) or the concurrent cohort (RR 1.52, 95% CI 1.15 to 2.53) were. CONCLUSION: Rooming-in might ease opioid-exposed newborns' transition to extrauterine life and promote more effective mothering.