Monday, May 9, 2016

NPR series on Neonatal Abstinence Syndrome

My son, Artie, resting in the NICU
When my second son was born via emergency c-section, he spent a week in the NICU out of an abundance of caution. It wasn't fun, but Artie pulled through just fine. He is a fat, happy four month old now.

While we were there, I found out that many of the other NICU babies there were suffering from neonatal abstinence syndrome (NAS). They were born addicted to drugs. And those poor babies howled for hours as they were being weaned off of drugs and helped by the staff.

NPR's All Things Considered recently did a series about national efforts to help end NAS. Two of the segments from this series are potential leaning moments for statistics and RM classes. One discusses efforts to use proper research methodology to create the ideal treatment recommendations for NAS babies. The second discusses governmental efforts to use systematic data collection to better track NAS babies and get to the root of the problem.

1. Using clinical research to better treat NAS babies

NAS babies are born addicted to drugs and need to be weaned off of those drugs after birth. Detox is awful. To aid these babies, they are typically given smaller and smaller dosages of morphine or methadone in order to ease the detox process. However, there are no established guidelines for dosages. This NPR story briefly describes the research design for a proposed study that hopes to a) figure out which is better for babies: Methadone or morphine via b) longitudinal research. As I psychologist, I think it is also worth noting that this research has been proposed by developmental psychologists.

As such, I think this can be used in a statistics or RM methods class to demonstrate a real world problem and how psychologists are conducting research to better understand this problem. This particular example would also be suited to a developmental psychology class or a psychology class dedicated to drug abuse and addiction. I think this example also illustrates larger issues related to why this hasn't been studied yet: Research on infants already has many restrictions, rightly so. Imagine what it is like to write the IRB proposal related to dosing infants with morphine and methadone, even when it is a medical necessity.

2. Using systematic data collection to better understand NAS

As a Pennsylvanian, I'm especially pleased to hear this story from NPR about my state's efforts to better track data regarding children born with NAS. It seems like it should be very straight forward to track these babies, but there hasn't been a unified, organized way to do so. However, they are going to add this condition to the list of diseases, like TB and whooping cough, that the Department of Health specifically tracks with the help of physicians.

Why should we collect such data? To better understand the problem. A tracking program in Tennessee uncovered the fact that many of the mothers of NAS babies are receiving their drugs via perfectly legal prescriptions. This insight, provided by data, may lead to new avenues for preventing NAS by better educating doctors on pain management for pregnant women.

I think this can be used in class as an example of applied statistics within medicine. It also demonstrates that just because it might seem intuitive to collect certain data does not mean that such data is being collected. It also shows how such data can inform policy and problem solving (like the approach of educating doctors about precautions to take when prescribing opiates to pregnant women).