State achieves State of Excellence in Education and Training award for neonatal abstinence syndrome

Vermont Oxford Network (VON) has awarded a “State of Excellence in Education and Training for Infants and Families Affected by Neonatal Abstinence Syndrome” designation to the state of Tennessee in partnership with the Tennessee Initiative for Perinatal Quality Care (TIPQC) and supported by Vermont Oxford Network with the goal of standardizing care for infants and families affected by neonatal abstinence syndrome (NAS).

The award recognizes that at least 85 percent of multidisciplinary care teams participating in the “Neonatal Abstinence Syndrome Collaborative: Improving Care to Improve Outcomes” completed universal training for care of neonatal abstinence syndrome (NAS).

Neonatal abstinence syndrome is drug withdrawal syndrome experienced by infants exposed to opioids while in utero. Infants born with NAS are more likely to have respiratory complications, feeding difficulty, low birthweights, and extended hospital stays.

Tennessee Initiative for Perinatal Quality Care (TIPCQ) partnered with VON to provide 30 hospitals universal training designed to standardize care policies. The collaborative approach to universal training included rapid-cycle distribution of current evidence-based practices to the entire interdisciplinary workforce engaged in caring for substance-exposed infants and families. This approach has been proven to reduce length of hospital stay and length of pharmacologic treatment while increasing family satisfaction.

“Congratulations to all the care teams across the state of Tennessee who have shown how dedicated the state is to caring for the most vulnerable population affected by the national opioid epidemic.”

Jeffrey Horbar, Chief Executive and Scientific Officer of VON

As a global leader in data-driven quality improvement for newborn care, VON leads multi-center quality improvement collaboratives and provides resources to help interdisciplinary teams improve on the most critical and complex challenges facing newborn caregivers. While more than 250 centers nationwide have completed VON’s universal training for NAS, Tennessee is the third statewide collaborative to achieve the Excellence in Education and Training distinction.

Congratulations to these hospitals receiving the designation as a VON Center for Excellence:

  • Baptist Memorial Hospital
  • Cookeville Regional Medical Center
  • East Tennessee Children’s Hospital
  • Erlanger East Hospital
  • Fort Sanders Regional Medical Center
  • Hardin Medical Center
  • Henry County Medical Center
  • Jackson Madison County General Hospital
  • Johnson City Medical Center
  • Maury Regional Medical Center
  • Methodist Le Bonheur Germantown Hospital
  • Methodist South Hospital
  • Regional One Health
  • Saint Thomas Midtown Hospital
  • Saint Thomas River Park Hospital
  • Saint Thomas Rutherford Hospital
  • St. Francis Hospital
  • St. Francis Hospital Memphis
  • Sumner Regional Medical Center
  • West TN Healthcare – Dyersburg
  • The Children’s Hospital at TriStar Centennial
  • TriStar Hendersonville Medical Center
  • TriStar StoneCrest Medical Center
  • University of Tennessee Medical Center
  • Vanderbilt Tullahoma – Harton
  • Williamson Medical Center

About Vermont Oxford Network

Vermont Oxford Network (VON) is a worldwide community of health care professionals dedicated to improving the quality, safety, and value of care for newborn infants and their families through a coordinated program of data-driven quality improvement, education, and research. Members use confidential information from the world’s largest and most comprehensive databases of infant data to benchmark their practices and outcomes and identify areas for improvement. Teams from around the world address critical and complex challenges of newborn care with evidence-based quality improvement methods guided by VON expert faculty and resources. www.vtoxford.org.

Every NICU parent remembers admission day! It is a new environment with new sounds, small babies, that might be your own, and a completely new care team with a medical language you have to learn.   Upon admission, the first few encounters a parent has with their baby’s care team is the most crucial and telling sign as to how family centered that unit is.  As a parent, you are scared; do not understand fully what is happening to your baby or why they are truly in the NICU.   Those first encounters with the care team can be vital in nurturing parent or caregiver engagement and trust.   Each baby’s diagnosis is unique, resulting in different ways that parent can nurture and care for their baby.  Even if the baby is on a ventilator, there are ways parents can comfort and increase the bond with their child.   Fostering that relationship among the parents and the care team benefits both sides.

Family engagement has shown to have many potential benefits that include a shorter length of stay, decreased readmission, reduced parental stress, increased confident after discharge, and increased staff satisfaction. Taking just a few minutes with parents to show them how they can collaborate with the care team to help improve their baby’s outcome will result in a true family centered care approach with lasting benefits.  

Mary Catherine Tagg Burke is the Director of Special Events at Regional One Health Foundation and is an active TIPQC Board Member.

The month of August is National Breastfeeding Month and provides an opportunity for us to reflect on breastfeeding rates and practices.  The CDC recently released the results of the revised Maternity Practices in Infant Nutrition and Care Survey (mPINC).  Forty-four of Tennessee’s birthing hospitals completed the survey and the state received a score of 72/100 or 49th place (out of 51). View the full report here.

What are the TN opportunities for improvement?

  • Provide uninterrupted skin to skin time after delivery
  • Encourage mom and baby to share a room and perform all care in that space
  • Purchase formula (like other hospital items) and stop giving free samples / industry sponsored gifts to families
  • Avoid non-medical supplementation
  • Develop a written policy that supports best breastfeeding practices

Why are these practices important?  The state of Tennessee traditionally lags behind the US average in breastfeeding initiation but over the past 5 years or so, we have made modest gains so that 80.8% of our TN infants had breastfeeding initiated.  But we must look deeper into that percentage and ask ourselves is that equitable to all infants?

Sadly, the answer is NO!  The breastfeeding initiation rate of Non-Hispanic Black Infants continues to be lower than that of Non-Hispanic White Infants, although the optimist in me sees that the gap is closing a little maybe due to hard work of groups like BSTARS (www.shelbycountybreastfeeding.org) and ROSE (www.breastfeedingrose.org).  We must be purposeful in addressing this disparity.  What are some concrete steps that you can take in your settings?  We would love to hear your ideas!

Anna Morad, MD, FAAP is an Associate Professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt in the Division of Academic General Pediatrics, and is the Medical Director of the Newborn Nursery. She is also the current active Infant Medical Director for the Tennessee Initiative for Perinatal Quality Care.

World Breastfeeding Week is celebrated each year the first week of August to promote and bring attention to providing breast milk to babies, by direct feeding at the breast or pumping and providing expressed breast milk. 

Breast milk is especially desired for the opiate exposed neonate (OEN). It provides majority of all infant nutritional needs, can bring closeness of mom to baby, gives mom a sense of connection and success, may provide some physical advantages to mom,  may decrease withdrawal for the infant, easier for the infant to digest, passes immunities to baby and many other positives. 

Most infants may need to be supplemented the first few days due to the increased expenditure of calories because of withdrawal. Adding more calories with formula and volume is short term until her own milk increases. Each infant is unique and evaluated for a feeding plan that will suit their individual needs. 

We strongly encourage mom to begin pumping as soon as possible after delivery.  Infants may have a disorganized suck or a difficult time latching to breast. Or, mom may not feel comfortable with infant at breast but providing breast milk to her baby is important. 

Moms that are not eligible to breastfeed or provide EBM are moms that have relapsed within 30 days of delivery or moms that are not in active treatment and do not desire to stop their drug use.

Providing breast milk to OEN babies is beneficial to mom and baby, at breast or by pumping. Supporting this particular dyad in a caring open atmosphere where mom feels she can succeed, we can help to give this mom and baby a great beginning.

Betty McDaniel-Thomas, RN, IBCLC is currently a Lactation Consultant at Vanderbilt Medical Center and Monroe Carroll Jr. Children’s Hospital, and is also an active TIPQC member and stakeholder.

Maternal mortality is increasing in America and Tennessee and cardiovascular causes are the most common reasons of pregnancy associated mortality. Blacks are three to four times more likely to die from pregnancy related causes than white mothers in Tennessee. To date, no consistent body of literature has shown that underlying biology is a causal link to racial disparity in adverse pregnancy outcomes. It is often reflexive first to blame patient factors such as lack of education, lower socioeconomic status and inadequate prenatal care. However, national data has demonstrated that while these factors contribute to maternal mortality overall, it does not entirely explain the observed disparities. Studies has demonstrated that players in the medical  system have racial bias that impacts the delivery of healthcare. Previously, racism was thought of as a social issue separate and distinct from racial health disparities. In these unprecedented times during this Covid-19 pandemic and racial unrest, it clear that systemic racism steeped in the history of our nation has played a pivotal a role in propagating the health disparities including maternal and infant health. For this reason, we have a mandate to deliberately act to mitigate the casualties of racism in maternal/ infant health in Tennessee. While universal unconscious bias training will help in addressing the provider contribution to racial disparities, there remains a need  to mitigate unequal access, treatment and adverse outcomes in maternal and infant health in measurable ways. Addressing racism, social determinants of health and recommending the consistent delivery of culturally sensitive health care is an important charge for TIPQC and its members and will promote health equity for Tennessee families.

Rolanda Lister, MD is a Maternal Fetal Medicine specialist at Vanderbilt University Medical Center and the Officer of Health Equity for the Tennessee Initiative for Perinatal Quality care