Dr. Adam Czynski, DO, is a Neonatologist at Women & Infants Hospital in Providence, Rhode Island. He attended and graduated from Philadelphia College of Osteopathic Medicine in 2006, completed his pediatric residence at the Medical College of Virginia at Virginia Commonwealth University, and his neonatology training at Loma Linda Children’s Hospital in southern California. He is currently the Medical Director of the Mother Baby Unit at Women & Infants. The Mother Baby Unit is a combination unit providing newborn nursery care and care to substance exposed newborns.
Dr. Czynski current research interests are in the field of Neonatal Abstinence Syndrome. He worked as the site PI for the B.A.B.Y Trial which was a prospective clinical trial comparing morphine vs methadone for the treatment of NAS. For the COBRE he is planning to compare the effects of buprenorphine vs morphine for the treatment of NAS. Dr. Czynski is also the PI for a weaning trial comparing the rapid vs slow wean taper for the treatment of NAS that will be conducted throughout the Neonatal Research Network and the IDeA State Pediatric Clinical Trial Network. In addition to investigating pharmacologic treat of NAS he is also focusing on the long term neurodevelopmental and behavioral effects of fetal opioid exposure. Dr. Czynski in collaboration with the Rhode Island Department of Health have developed a care map for infants with fetal opioid exposure. The care map connects hospital based and community based family resources to support parenting, sobriety, and maximize infant development. Dr. Czynski and Dr. Barry Lester also established the state’s first long term developmental follow up clinic exclusively for opioid exposed newborns. Prior to Dr. Czynski’s work in NAS he work on developing NICU based disaster response plans and lead regional disaster response efforts to NICUs across southern California.
Opioid use disorders are a public health concern of epidemic proportion. Our project will contribute significantly to this COBRE on Opioids and Overdose, as misuse of opioids during pregnancy effects infants, our most vulnerable population. The focus of this project is on Neonatal Abstinence Syndrome (NAS), the withdrawal that infants suffer after being born to a mother who is dependent on opioids. NAS has increased fivefold since 2000, now affecting 60-80% of infants exposed to opioids in utero. The cost to treat NAS in 2012 was $1.5 billion with the majority of infants enrolled in state sponsored insurance programs. NAS is typically treated by the reintroduction of opioids (morphine or methadone and more recently, buprenorphine) followed by gradual weaning and increasingly with non-pharmacological interventions as well (e.g. rooming-in). Unfortunately, treatments are not evidence-based and there are no standardized protocols resulting in a wide variability in the management of these infants and the potential for mismanagement. The overall objective of this proposal is to develop the evidence based tools needed to define best practice and develop a standardized approach to improve the treatment and management of infants with NAS. Our central hypothesis is that establishment of a standardized perinatal to postnatal treatment program for maternal opioid dependency and the management of NAS will shorten length of stay and length of treatment, reduce health care costs, and prevent or mitigate potential adverse long term neurodevelopmental outcomes. In this project we propose to 1) develop a multidisciplinary, buprenorphine-based prenatal care model for pregnant women being treated for opioid use disorders, 2) conduct a single center randomized control trial of buprenorphine vs. morphine for NAS, and 3) develop a preliminary Risk Stratification Safety Assessment tool (RSSA), using Classification and Regression Tree (CART) statistical decision making analysis to help determine which families are most at risk of medication noncompliance. By tailoring treatment prenatally and removing barriers to novel interventions and working synergistically with the Cores we will transform our current approach the treatment and management of NAS.
Davis JM, Shenberger J, Terrin N, Breeze JL, Hudak M, Wachman EM, et al. Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Clinical Trial. JAMA Pediatr. 2018;172(8):741-8.
Czynski AJ, Terry MH, Deming DD, Power GG, Buchholz JN, Blood AB. Cerebral autoregulation is minimally influenced by the superior cervical ganglion in two- week-old lambs, and absent in preterm lambs immediately following delivery. PLoS One. 2013;8(12):e82326.
Roberts KD, Brown R, Lampland AL, Leone TA, Rudser KD, Finer NN, et al. Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial. J Pediatr. 2018;193:40-6 e1.
Barry Lester, PhD Professor of Psychiatry & Human Behavior and Pediatrics and Director of the Brown Center for the Study of Children at Risk
Brown Alpert Medical School and Women & Infants Hospital Barry_Lester@brown.edu
NIGMS 1P20GM125507 Sub-Project ID: 8301 (Czynski)
PROJECT 4: NEONATAL ABSTINENCE SYNDROME (NAS): FETUS TO FIRST YEARS