NASCEND
Transforming Care for Infants with Neonatal Abstinence Syndrome

Caring for infants with neonatal abstinence syndrome (NAS) can be costly and complex. NAS can occur when babies are exposed to drugs, especially opioids, in the womb. This exposure can lead to fetal growth restriction, prematurity, and newborn withdrawal with a constellation of neurological, gastrointestinal, respiratory, and autonomic symptoms. These symptoms can impact an infant’s nutrition and growth, prolong newborn hospital stay, and increase healthcare costs. Infants with NAS often need to be transferred to a higher level of care such as the NICU or special care nursery (SCN) to monitor symptoms and administer pharmacologic treatment as appropriate.

Dr. Dawn Forbes, a practicing neontologist, recognized that the lack of standardization in the care, assessment, and treatment of these infants was leading to disparities in healthcare with variable and concerning outcomes. Wanting to address this problem, she led her neonatal practice in a quality initiative. After showing favorable outcomes locally, Dr. Forbes endeavored to advance care nationally and collaborated with her colleagues to establish NASCEND™, a certified B-corporation that balances purpose with profit while using business as a force for change.

“Our mission is to be the national standard, transforming the care and medical outcomes of infants and moms affected by maternal substance use disorder (SUD),” says Dr. Forbes, M.D., M.S., FAAP, founder of NASCEND.

Bringing a Universal Solution for NAS

NASCEND provides certified hands-on, live, and virtual training, that improves and standardizes the care for NAS through nurse driven, infant focused, and comfort first care modalities combined with integrated apps for assessment, treatment, and advanced comfort. By offering actionable guidelines, resources, and recommendations, any healthcare provider can truly change their course of the care from day one of the training.

The training curriculum covers topics on understanding opioid addiction, destigmatizing maternal care, trauma informed approach to care, engaging parents; improving infant assessment, treatment, and nutrition; advanced comfort care with music integration, and developmental outcomes.

NASCEND’s continuum of care is multidisciplinary and comprehensive, engaging and educating providers and families as early as the first trimester, continuing with in inhospital newborn care and up to three-year developmental and nutritional pediatric follow-up. This approach enables providers to improve care for both immediate and long-term outcomes. The intent behind the early intervention is the belief in ‘healthy mom, healthy baby.’

NASCEND also developed a music app, LULLABY, designed to improve infant sleep, comfort, and feeding through the use of AAP-recommended music. LULLABY features playlists, real-time karaoke, and the ability to record your song, and create your own original lullaby.

Made Assessment Easier And Decreased the Need to Treat

Providers continue to rely on the Finnegan NAS scoring system, developed in 1975, for NAS assessment, despite many considering it a long and complex tool that results in over treatment, increased length of hospital stay, and increased healthcare costs.

NASCEND makes the assessment simpler with its AssessPro app. Based on six informative symptoms with a question driven algorithm that prioritizes comfort care over pharmacology, the app is designed to decrease subjectivity, minimize user bias, and improve assessment accuracy. A key differentiator of AssessPro is that it provides both an individualized assessment and real time treatment recommendations resulting in better decisions with decreased need to treat.

Walking the Talk with Proven Results

The first level II NICU to complete NASCEND’s live training program, a healthcare organization in Southern Indiana, just recently submitted their 18 month outcomes post training. They reported a significant improvement in the quality of care and delivery of effective outcomes for their moms and infants. Leveraging the AssessPro app, they demonstrated a 74 percent reduction in the need for NAS treatment, a 50 percent reduction in the length of treatment, and a 37 percent decrease in the length of hospital stay when treatment was necessary. Today, the organization maintains a mere 11 percent treatment rate for NAS.

To date, NASCEND has trained over 7000 healthcare providers in 38 different states, improving the lives of 1.4 million infants. Moving ahead, NASCEND looks to continue to train and certify healthcare systems nationally to improve the care and outcomes for opioid exposed infants, while advancing our next generation of resources, technology and apps.