Maternal, Infant, and Child Health
IHS and AAP Release Clinical Recommendations to Improve Care of American Indian, Alaska Native Women and Infants Impacted By Prenatal Opioid Exposure
The Indian Health Service and the American Academy of Pediatrics Committee on Native American Child Health released clinical recommendations on neonatal opioid withdrawal syndrome, or NOWS, for IHS, tribal, and urban Indian organization health care facilities. These recommendations provide standards of care surrounding screening, diagnosing, and treatment of pregnant mothers and infants affected by prenatal opioid exposure.
"Infants born withdrawing from opioids represent one of the most heartbreaking aspects of our country's addiction crisis, which has hit American Indian and Alaska Native communities especially hard," said HHS Secretary Alex Azar. "The new clinical recommendations will help elevate the quality of care offered to mothers and infants affected by the opioid crisis, and this cooperative project reflects the priority that the Trump Administration has put on addressing substance abuse and increasing the quality of care provided through the Indian Health Service."
"At IHS, we recognize that preserving the infant-mother relationship is of the utmost importance," said IHS Chief Medical Officer Rear Adm. Michael Toedt, M.D. "These recommendations further establish the need for ongoing monitoring and clinical management of opioid-exposed infants to improve health outcomes as part of our comprehensive strategy to address the opioid epidemic."
The recommendations will serve as a resource to improve identification, care, and outcomes of infants at risk for NOWS. The recommendations were developed based on critical feedback the IHS received on the importance of prenatal opioid exposure in opioid listening sessions and tribal consultations throughout the past year.
"American Indian and Alaska Native women face significant barriers in obtaining appropriate care for substance use disorders while pregnant, which may delay early intervention efforts that are best for the newborn's health," said Shaquita Bell, M.D., FAAP, chair of the AAP Committee on Native American Child Health. "AAP is proud to partner with IHS to support efforts to prevent neonatal opioid withdrawal syndrome, to provide the most appropriate and effective treatments for infants and keep them connected with their families and communities."
The recommendations are also a companion guide to clinical recommendations to improve care of American Indian and Alaska Native pregnant women and women of childbearing age with opioid use disorder, which were announced by IHS and the American College of Obstetricians and Gynecologists in March 2019.
Maintaining relationships and forging new partnerships with tribes and tribal health organizations in rural and urban Indian communities are essential to addressing the opioid epidemic and caring for American Indian and Alaska Native mothers, infants, and families affected by NOWS. The IHS engages with communities and partners with tribes to promote evidence-based programs and policies to support recovery, as well as prevention efforts. The IHS is committed to developing strategies to implement these new recommendations that include sharing best practices in comprehensive care approaches, collaborating with community service providers, and sharing training and patient education resources.
NOWS occurs in 55-94 percent of infants prenatally exposed to opioids and varies in severity from mild to, in rare cases, life-threatening. Management of NOWS begins with identifying women at risk for opioid withdrawal to improve outcomes for both mothers and newborns and help to keep the family unit together.
Health and Human Services Secretary Alex Azar has identified ending the crisis of opioid addiction and overdose in America as one of the department's top priorities and an area of focus as an impactable health challenge. In 2017, the Department declared a public health emergency and announced a 5-Point Strategy to Combat the Opioid Crisis.
The IHS National Committee on Heroin, Opioids and Pain Efforts, or HOPE Committee, was established to promote appropriate and effective pain management, reduce overdose deaths from heroin and prescription opioid misuse, and improve access to culturally appropriate treatment.
The recommendations are available https://www.ihs.gov/opioids/childhealth/