Summer 2018

Help for the Most Helpless

A new app seeks to aid a growing number of drug-exposed newborns.

By Monica Jimenez

Previous Next

Illustration: Alex Nabaum

As the opioid epidemic rages, more and more health professionals are treating newborns who have been exposed to drugs. “On any particular day, we can have ten to twelve babies withdrawing from narcotics,” said Tufts Medical Center Chief of Newborn Medicine Jonathan Davis, who works with eight hospitals affiliated with the Tufts University School of Medicine.

Thanks to Davis, doctors from Massachusetts General Hospital and Baystate Medical Center, and the Cambridge-based company Dimagi, there will soon be an app to help. Called NASCare and developed with $1 million in federal funding over two years, the app will guide health professionals caring for drug-exposed newborns—especially physicians at community hospitals who lack the expertise or resources to treat them—and help standardize protocols.

Currently, most institutions use the Finnegan Scoring Tool to evaluate twenty-one common signs of neonatal abstinence syndrome (NAS)—including convulsions, poor feeding, high fever, and moist skin—and choose the appropriate treatment. But the parameters aren’t cut-and-dry, and scoring is subjective: People have different definitions of what constitutes high-pitched crying or moderate tremors, for example. Opinions also vary about when to give pharmacological treatment. “No one is establishing best practices, which is a major flaw in our system,” Davis said.

NASCare aims to change that, offering an interactive method to measure NAS symptoms. The tool will include features to mitigate subjectivity in scoring—such as videos of babies with varying degrees of tremors and recordings of infants crying at different pitches—plus data previously collected on each newborn so physicians can assess progress over time. It will also suggest treatment protocols for each score based on the latest research and industry best practices. “This will hopefully make interpretation easier and ratings more reliable across different doctors and nurses, even those with less experience dealing with this population,” said Xian Ho, senior researcher at Dimagi. At Davis’ urging, suggestions such as feeding and wrapping the baby, or keeping the infant in a dark, quiet place will be encouraged before pharmacological treatments—but there will also be guidance for putting a newborn back on opioids to control the symptoms, then slowly weaning them off those drugs.

Finally, the app will offer a continuing medical education curriculum developed by Davis, his colleagues, and Harvard Medical School, which will also address newborns exposed to marijuana. Davis called that a rising population, pointing to a 2017 study in the Journal of the American Medical Association showing that from 2002 to 2014, the prevalence of self-reported, past-month marijuana use among U.S. adult pregnant women increased from 2.4 percent to 3.9 percent. “With marijuana use being widely legalized, people assume it must be safe,” Davis said. “But marijuana is being engineered with much higher concentrations of THC.” Between 1995 and 2014, the THC content of illicit marijuana seized by the U.S. Drug Enforcement Administration increased from four to twelve percent, according to a 2016 report in the journal Biological Psychiatry. “We really haven’t studied the long-term neurological effects,” Davis added.

NASCare will evolve as new information emerges. Eventually, developers hope to add functionality for users to collect data on new treatment methods to help researchers evaluate their effectiveness. The next steps, though, are to wrap up content development and test the app with representative users. Then the Android app will be made available to medical professionals at Tufts-affiliated hospitals for a clinical trial, before it’s rolled out for paid use by other institutions (iPhone compatibility is also in the works). “We’re very proud of this project because it is really addressing an immediate need,” Ho said. “This is a terrible issue that families face in the U.S. and providers are dealing with in hospitals.”

The NASCare project has been funded in whole or in part with federal funds from the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN271201700065C.

Top Stories

Taking on TB

Bree Aldridge and her team are revolutionizing how we understand and treat this deadly disease.

What Matters Most

Tufts alum Dawn Gross on why hard conversations about life and death are so important to have right now.

Right on Track

A look at the successes and future of the Maine Track program, a partnership between the School of Medicine and Maine Medical Center.

Editor's Picks

When Medicine Meets Fiction

A pediatric cardiologist reaches young patients through literature.

Swinging Shape

Improve your game and your health with these tips from the Golf Doc.

Staving Off Burnout

Jody Schindelheim helps budding physicians grapple with the emotional burdens of the profession.

Keeping Tabs on Hypertension

A new wearable device puts Tufts on the frontlines in fighting high blood pressure.