Dr. Lisa Cleveland is a Pediatric Nurse Practitioner and a tenured Associate Professor at UT Health San Antonio, School of Nursing. Her innovative research with mother-infant dyads impacted by opioid use has contributed to changes in clinical practice and improved outcomes. Her recovery residence, Casa Mia, is a collaborative partnership between the School of Nursing and the nonprofit, Crosspoint, Inc. Casa Mia provides safe and supportive housing for pregnant and parenting women with opioid use disorder where they can recover with their children.
In addition, the findings of Dr. Cleveland’s Maternal Opioid Morbidity Study are providing insight into the contextual factors surrounding maternal opioid use relapse and overdose deaths; the leading cause of maternal mortality in TX and a growing cause nationwide. Dr. Cleveland is now developing and psychometrically analyzing a brief screening instrument to help identify women at-risk for overdose death so they may be referred to life-saving resources. Further, Dr. Cleveland is leading the Texas Targeted Opioid Response to ensure access to Narcan: https://www.morenarcanplease.com/, and opioid overdose identification and reversal education. She is also leading a community paramedicine project to prevent overdose, increase the use of peer recovery services, and improve access to treatment.
Between the 2000 and 2009, the use of opioids, such as heroin or prescription pain relievers, during pregnancy increased fivefold. Prenatal opioid exposure can result in newborn withdrawal symptoms often called Neonatal Abstinence Syndrome (NAS). NAS can include inconsolable crying, sleeplessness, and poor feeding. National rates of NAS have tripled since 2000. Opioid detoxification during pregnancy is not recommended and is linked to preterm labor and fetal distress. Therefore, it is recommended that pregnant women with opioid use disorder be stabilized on medication assisted treatment (MAT). However, these medications may still result in newborn withdrawal.
Treatment of NAS is typically focused on symptom management using soothing techniques and medications. Soothing techniques are non-pharmacological comfort measures and are considered the first line of care for infants with NAS. However, these techniques can be difficult to implement in a busy nursery environment. Medications may alleviate some NAS symptoms but, the use of medication is linked to a longer and more costly hospital stay and prolonged separation of mother and infant. As such, the purpose of this presentation is to explore best practices in the care of the opioid impacted mother-infant dyad with an emphasis on the important role of the biological mother.
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