In brief
A NICHD K23 proposal to study the under-examined first year after discharge for infants with neonatal opioid withdrawal syndrome (NOWS), aiming to quantify readmission risks and costs and to inform a home-visiting model. It sets out aims, not results.
What this article is about
Quick Answer
A NICHD K23 proposal to study the under-examined first year after discharge for infants with neonatal opioid withdrawal syndrome (NOWS), aiming to quantify readmission risks and costs and to inform a home-visiting model. It sets out aims, not results.
Student takeaways
Key Takeaways
- This is a National Institute of Child Health and Human Development K23 career development award (a funded proposal), so it presents aims and rationale about post-discharge care for infants with NOWS rather than completed results.
- The abstract cites background data that rising prescription and illicit opioid use among women of childbearing age has produced roughly a five-fold increase in neonatal opioid withdrawal syndrome (NOWS) over two decades.
- It reports that monitoring and managing infants with NOWS prolongs birth hospitalization, with national hospital costs cited as exceeding 560 million dollars annually, and notes dyadic approaches such as the Eat, Sleep, Console protocol.
- The identified gap is the under-studied period after discharge: the proposal aims to quantify first-year hospital readmission risks and costs and to understand challenges in keeping infants with NOWS healthy and safe at home.
- The abstract highlights that this is a vulnerable time because mothers with opioid use disorder are at high risk of relapse and overdose in the first postpartum year and the risk of abuse or neglect is highest in the first year of life; the long-term aim is an evidence-based home-visiting model of care.
Student summary
Why This Research Matters
This record is a funded research proposal (a K23 career development award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development) rather than a completed study. It describes aims, background, and rationale, not results. The focus is neonatal opioid withdrawal syndrome, abbreviated NOWS, and specifically the less-studied period after a newborn leaves the hospital, during the first year of life. Because it is a proposal, it does not report what the research found; it explains what the investigator plans to learn and why.
Neonatal opioid withdrawal syndrome is a set of withdrawal symptoms that can occur in a newborn who was exposed to opioids before birth. The abstract explains that rising use of both prescription and illicit opioids among women of childbearing age over the past two decades has led to a roughly five-fold increase in NOWS. Caring for these infants often requires close monitoring and management, which prolongs their hospital stay after birth. The abstract cites national hospital costs that currently exceed 560 million dollars per year. It notes that several approaches have been tried to reduce this burden during the birth hospitalization, including dyadic (mother-and-baby together) approaches such as the Eat, Sleep, Console protocol, which focuses on the infant's functioning and on keeping mother and baby together rather than relying only on medication and rigid scoring.
The key gap this proposal addresses is what happens after discharge. The abstract argues that far less attention has been paid to the clinical needs and the trajectory of care for infants with NOWS during the rest of infancy, including their risk of hospital readmission and the costs that go with it. Understanding this period matters because it is a vulnerable time for both mother and child. The abstract notes that mothers with opioid use disorder, abbreviated OUD, are at high risk of relapse and overdose during the first year after giving birth, and that the risk of abuse or neglect for any child is highest in the first year of life. The project therefore aims to understand the challenges of keeping infants with NOWS healthy and safe in the year following discharge.
The plan has two study aims. The first would quantify the risks and costs of hospital readmissions during the first year of life for infants with NOWS. The second would focus on the challenges of keeping these infants healthy and safe after they go home. As a career development award, the project is also meant to build the investigator's skills, an epidemiologist with a background in pediatric nursing, in the clinical care of infants with NOWS and in working skillfully with mothers who have OUD, as well as in economic evaluation, qualitative methods, and implementation science. The stated long-term goal is to use these findings to help design an evidence-based, home-visiting model of care tailored to the needs of families affected by NOWS after discharge.
For a nursing student, the appraisal points are important. First, this is a plan, so the readmission risks and costs after discharge are the questions being studied, not established results; only the background figures, such as the five-fold rise and the 560-million-dollar hospitalization cost, are drawn from prior data cited in the abstract. Second, the proposal relies on analyzing large datasets and later qualitative work, approaches that can reveal patterns and lived experience but also have limits, such as depending on the completeness of records.
The topic demands sensitivity and a non-judgmental, trauma-informed stance. Opioid use disorder is a treatable medical condition, and stigma toward mothers can drive families away from care at exactly the time they most need support. The healthiest framing centers the mother-infant dyad, supports recovery and safe caregiving, and avoids blame. A gentle caution: mentions of relapse, overdose, and child abuse or neglect describe real risks that call for compassionate assessment, safety planning, and connection to resources, not alarm or punishment. Nurses can support these families now through respectful, dyadic care, careful discharge planning and follow-up, education for caregivers, and linkage to home-visiting and treatment services, while advocating for the infant's safety and the mother's recovery together.
Source abstract
Study Overview
PROJECT SUMMARY The increased use of both prescription and illicit opioids among women of child-bearing age over the past two decades has resulted in a five-fold increase in neonatal opioid withdrawal syndrome (NOWS). The requisite monitoring and management of infants with NOWS prolong postnatal hospitalization, resulting nationally in hospital costs that currently exceed $560 million annually. Multiple approaches have been investigated to reduce the substantial care and cost burden of treating infants with NOWS postnatally, including through dyadic approaches such as the Eat, Sleep, Console protocol. Far less attention has been paid to understanding the clinical needs and subsequent trajectory of care for infants with NOWS during the remainder of their infancy— including their risk of hospital readmission and the associated costs. A clearer understanding of these issues is integral to developing protocols to assist mothers with opioid use disorder (OUD) in caring for their infants during a time when the health care needs of both the mother and the child are great. Mothers with OUD are at high risk of relapse and of overdose during the first postpartum year. In turn, the risk of abuse or neglect is highest for all children in the first year of life. Thus, the objective of this career development proposal is to understand the challenges of caring for infants with NOWS in the year following discharge from the birth hospitalization. The first study aims to quantify the risks and costs of hospital readmissions during the first year of life for infants with NOWS. The second study will focus on the challenges of keeping infants with NOWS healthy and safe in the year following discharge from the birth hospitalization, a vulnerable time for both mother and child. Long-term, my goal is to use these findings to inform the development of an evidence-based model of care within the home-visiting framework that addresses the unique needs of families affected by NOWS following discharge from the birth hospitalization. In applying for this award, I am seeking to develop the skills I need to successfully transition into the field of NOWS research. As an epidemiologist with a background in pediatric nursing, I have spent the past 12 years investigating the impact of the opioid crisis on adults (and to a lesser extent, children and adolescents) through secondary analyses of large datasets. I need further training related to 1) the clinical care of infants with NOWS and skillfully working with mothers with OUD, 2) economic evaluations, 3) qualitative research methods, and 4) implementation science. I have assembled a mentorship team led by experts in parental substance use and child abuse that addresses each area of training and leverages the resources available at Yale. The training and research outlined in this proposal promise to have a high impact on my career, as they will provide me with the skills and knowledge that I need to meet my long- term career goal of developing expertise in designing substance use interventions that are evidence-based, cost- effective, and informed by the lived experience of families.
Evidence appraisal
Main Findings
- This is a National Institute of Child Health and Human Development K23 career development award (a funded proposal), so it presents aims and rationale about post-discharge care for infants with NOWS rather than completed results.
- The abstract cites background data that rising prescription and illicit opioid use among women of childbearing age has produced roughly a five-fold increase in neonatal opioid withdrawal syndrome (NOWS) over two decades.
- It reports that monitoring and managing infants with NOWS prolongs birth hospitalization, with national hospital costs cited as exceeding 560 million dollars annually, and notes dyadic approaches such as the Eat, Sleep, Console protocol.
- The identified gap is the under-studied period after discharge: the proposal aims to quantify first-year hospital readmission risks and costs and to understand challenges in keeping infants with NOWS healthy and safe at home.
- The abstract highlights that this is a vulnerable time because mothers with opioid use disorder are at high risk of relapse and overdose in the first postpartum year and the risk of abuse or neglect is highest in the first year of life; the long-term aim is an evidence-based home-visiting model of care.
Practice transfer
Clinical Relevance
- Nurses should treat opioid use disorder as a treatable medical condition and use non-judgmental, trauma-informed care, since stigma can drive mothers and infants away from needed support.
- Care should center the mother-infant dyad, supporting the mother's recovery and safe caregiving together rather than separating the infant's needs from the mother's, consistent with dyadic approaches like Eat, Sleep, Console.
- Because the year after discharge is high-risk, thorough discharge planning, follow-up, and linkage to home-visiting and treatment services are important nursing priorities for families affected by NOWS.
- Nurses should recognize real risks named in the abstract, maternal relapse and overdose and elevated risk of infant abuse or neglect, and respond with compassionate assessment, safety planning, and resources rather than blame.
- Educating and supporting caregivers, and advocating for both infant safety and maternal recovery, can help keep infants with NOWS healthy and safe during a vulnerable first year.
Faculty notes
Educational Relevance
This is a K23 career development award from the National Institute of Child Health and Human Development, not a completed study, so its central questions, the post-discharge readmission risks, costs, and safety challenges for infants with neonatal opioid withdrawal syndrome (NOWS), are aims rather than findings. Use it to teach students to separate cited background statistics (an approximately five-fold rise in NOWS over two decades; national birth-hospitalization costs exceeding 560 million dollars annually; the Eat, Sleep, Console dyadic protocol) from the study's own to-be-determined results. The proposal is a strong anchor for discussing the mother-infant dyad, the treatable nature of opioid use disorder, and the harms of stigma, which can deter families from care. It also foregrounds real, sensitive risks named in the abstract, maternal relapse and overdose during the first postpartum year and the elevated risk of abuse or neglect in the first year of life, providing an opening to teach trauma-informed, non-judgmental care, safety planning, and the home-visiting framework as an intervention model. Methodologically, it illustrates secondary data analysis, economic evaluation, qualitative methods, and implementation science. Emphasize that no post-discharge outcomes are yet reported and that compassionate, dyadic, safety-focused care is the appropriate clinical stance.
Critical appraisal
Limitations
- This is a funded K23 proposal, not a completed study; the post-discharge readmission risks, costs, and safety challenges are questions to be studied, not reported results.
- The cited figures (roughly five-fold increase in NOWS and hospitalization costs exceeding 560 million dollars annually) are background statistics from prior data, not outcomes of this project.
- The planned work relies on secondary dataset analysis and later qualitative methods, which depend on the completeness and quality of underlying records and lived-experience accounts.
Classroom use
Discussion Questions
- Why is it important to recognize that this record is a proposal and that the post-discharge readmission risks and costs are questions, not established findings?
- What is neonatal opioid withdrawal syndrome (NOWS), and why has it become more common over the past two decades according to the abstract?
- What is a dyadic approach to care, and why might keeping mother and baby together (as in the Eat, Sleep, Console protocol) be beneficial?
- Why does the abstract describe the first year after discharge as a vulnerable time for both mother and infant?
- How should nurses balance concern for infant safety with compassionate, non-judgmental support for a mother with opioid use disorder?
- How can stigma toward mothers with substance use disorders affect whether families seek and stay in care?
- What is trauma-informed care, and how might it apply to families affected by NOWS?
- Why might strong discharge planning and follow-up be especially important for infants with NOWS?
- What are the strengths and limits of using large datasets to study readmission risks and costs?
- How could a home-visiting model of care support the health and safety of infants with NOWS and their families after discharge?
Search-ready answers
Frequently asked questions
Does this study report how often infants with NOWS are readmitted after discharge?
No. It is a funded proposal. Quantifying first-year readmission risks and costs is a stated aim, not a reported result.
What is neonatal opioid withdrawal syndrome (NOWS)?
A set of withdrawal symptoms in a newborn who was exposed to opioids before birth, often requiring monitoring and management.
Why has NOWS become more common?
The abstract cites rising prescription and illicit opioid use among women of childbearing age, tied to a roughly five-fold increase over two decades.
What is the Eat, Sleep, Console approach?
A dyadic, mother-and-baby-together approach used during the birth hospitalization to help reduce the care and cost burden of NOWS.
Why focus on the year after discharge?
Because that period is under-studied and is vulnerable for both mother and infant, including readmission risk and family safety.
Is opioid use disorder a moral failing?
No. It is a treatable medical condition. Stigma can push families away from care, so a non-judgmental, supportive approach is essential.
How should nurses balance infant safety and support for the mother?
By centering the mother-infant dyad, supporting recovery and safe caregiving together, and using trauma-informed assessment and safety planning rather than blame.
What real risks does the abstract name for this period?
Maternal relapse and overdose in the first postpartum year, and an elevated risk of abuse or neglect in the first year of life.
What is the long-term goal of this work?
To inform an evidence-based home-visiting model of care tailored to families affected by NOWS after discharge.
Can nurses act on this now?
Yes. Compassionate, dyadic care, strong discharge planning and follow-up, caregiver education, and linkage to treatment and home-visiting services all help during a vulnerable first year.