Rohde Jessica F, Canter Kimberly, Houff Madison, Bodt Barry, Pachter Lee M, Di Guglielmo Matthew D, Goyal Neera
Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Brandywine Pediatrics, Wilmington, DE, USA.
J Child Health Care. 2024 Dec;28(4):849-864. doi: 10.1177/13674935231168676. Epub 2023 Apr 12.
Opioid use disorder (OUD) during pregnancy has risen in the U.S. over the past two decades, resulting in a growing number of children with intrauterine opioid exposure (IOE). Limited research exists supporting best practices to optimize primary care for these children and their families, particularly mothers with OUD. Using a modified Delphi method, we surveyed pediatric primary care clinicians from a single children's health care system regarding their experiences in caring for this population. In Phase 1, open-ended survey questions inquired about needs and challenges facing these infants, their families, and clinicians and resources within primary care. After thematic analysis, the most frequent responses were presented as a Phase 2 survey for clinicians to select their top five. Percentages for the most commonly selected top five themes were tabulated. Survey response rates were 58/139 (42%) for Phase 1 and 45/137 (33%) for Phase 2. For infants with IOE and their families, respondents identified parenting knowledge and family issues related to maternal OUD as top challenges, with limited resources to address them in primary care. Clinicians identified time constraints and follow-up issues as top challenges. Future intervention in pediatric primary care could include addressing parenting education, resource gaps, and best practice recommendations in caring for children with IOE.
在过去二十年中，美国孕期阿片类药物使用障碍（OUD）的情况有所增加，导致越来越多的儿童在子宫内接触阿片类药物（IOE）。目前支持针对这些儿童及其家庭（尤其是患有OUD的母亲）优化初级保健最佳做法的研究有限。我们采用改良的德尔菲法，对来自单一儿童医疗保健系统的儿科初级保健临床医生进行了调查，了解他们在照顾这一人群方面的经验。在第一阶段，开放式调查问题询问了这些婴儿、他们的家庭以及临床医生在初级保健中面临的需求、挑战和资源。经过主题分析后，最常见的回答被作为第二阶段的调查呈现给临床医生，让他们选出前五项。对最常被选中的前五个主题的百分比进行了列表统计。第一阶段的调查回复率为58/139（42%），第二阶段为45/137（33%）。对于患有IOE的婴儿及其家庭，受访者将育儿知识以及与母亲OUD相关的家庭问题视为首要挑战，而在初级保健中解决这些问题的资源有限。临床医生将时间限制和随访问题视为首要挑战。未来在儿科初级保健中的干预措施可能包括开展育儿教育、填补资源差距以及提供照顾患有IOE儿童的最佳实践建议。
