An intervention mapping approach to closing the gap in maternal OUD and infant NOWS care: a study protocol

The increasing prevalence of pregnant and postpartum individuals affected by opioid use disorder (OUD) in the US is highlighted by the growing number of babies referred to the NICU for neonatal opioid withdrawal syndrome after birth. Despite advances in integrating mental health and substance use treatment into adult healthcare settings, no treatment models exist to integrate maternal OUD treatment and referrals into the pediatric care setting. Integrating maternal OUD treatment into the NICU could help mothers access care and improve maternal functioning, while preserving the dyadic bond and maintaining stability for the infant. This study will use implementation mapping to develop and refine strategies to support NICU setting buprenorphine induction for mothers of babies hospitalized with NOWS to ensure treatment meets the needs of both providers and patients. Aim 1 will identify the primary barriers and facilitators to implementing bedside NICU OUD treatment and referrals to ongoing outpatient care for postpartum women through in-depth interviews with local NICU providers. Aim 2 will use the insights gained in Aim 1 to guide a process of implementation mapping to generate a suite of implementation strategies to support co-located buprenorphine induction and referrals for treating pregnant women with OUD in the NICU. Finally, in Aim 3 we will refine and examine the feasibility and acceptability of the implementation strategies by surveying stakeholders (n = 32); and conduct a pilot case series (n = 20 mothers). This will allow us to determine the best composition of the treatment team, where care should be delivered, and how providers, patients, and stakeholders respond. Results will establish the acceptability and feasibility of integrating OUD care into the NICU setting and identify the most promising implementation strategies for supporting this model in future confirmatory trials testing the effectiveness of NICU bedside buprenorphine induction and referrals to treatment on maternal and pediatric outcomes. This study was registered at clinicaltrials.gov on 08/28/2024 (NCT06576323) https://clinicaltrials.gov/study/NCT06576323?term=R21DA058815&rank=1.