It started with stories. When the Provincial Council for Maternal and Child Health looked at access to care and practice changes to streamline the flow of Ontario’s smallest patients, several physicians spoke of the impact babies born to mothers who used narcotics and methadone were having on hospital beds.
These newborns have neonatal abstinence syndrome (NAS)—withdrawal symptoms from their mothers’ use of drugs. As Ontario has Canada’s highest rate of narcotic use, physicians were seeing more NAS cases and longer lengths of stay among these babies. In neonatal units, it was increasingly difficult to move patients from Level 3 critical care beds (for the sickest and ventilated babies) to Level 2 specialized beds once they’d improved. The suspicion was that the Level 2 beds were being blocked by the growing numbers of NAS babies.
The council turned to CIHI, where data showed that in 2003–2004, 171 infants had been diagnosed with NAS. In 2010–2011, there were 654 cases. That same year, NAS babies across the province used an average of 23.4 hospital beds per day, up from 5.6 a day in 2003–2004. What’s more, the average length of stay for a healthy newborn in 2004 was a day and a half, compared with nearly 14 days among NAS babies. By 2010–2011, that had dropped slightly to 13.1 days.
“What people thought was the case turned out to be the case, but the problem turned out to be much bigger than we thought,” says Dr. Kimberly Dow, a neonatologist at Kingston General Hospital. “I think everyone was shocked that 23 neonatal beds in the province were occupied by these patients every day.”
The council created an NAS working group, co-chaired by Dow, with a goal of encouraging early screening and helping clinicians determine how to best manage pregnant woman and their babies. The expert panel also wanted to see what could be done to prevent the problem. Although there’s no easy solution to preventing NAS, screening and treatment guidelines for newborns were in the group’s June 2011 report. Those guidelines have been disseminated to all neonatal units that care for Level 3 and Level 2 babies, and all practising pediatricians have been told about them. New clinical guidelines were also posted on the council’s website.
“People have been struggling with this population and how to manage it,” says Marilyn Booth, the council’s Executive Director. “We wanted a consistent approach to prevent every single hospital from having to figure it out for themselves.”
Dow says data was instrumental in focusing attention on NAS and improving safety for babies and their moms.
“Without it we wouldn’t have known the extent of the problem in the province. And you can’t do anything about it unless you know what you’re dealing with. It confirmed people’s concerns, but more than that, it surprised us. The extent of the problem was shocking.”