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Haas A. Identification of neonatal abstinence syndrome in the community: Infants born into Canada's opioid crisis. Paediatr Child Health 2019; 24:81-84. [PMID: 30996597 DOI: 10.1093/pch/pxy098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Opioid use in Canada continues to rise. Infants exposed to opioids in utero are at high risk for neonatal abstinence syndrome. Signs and symptoms of withdrawal may not develop before the infant is discharged home. Health professionals may be falling short in adequately identifying and supporting opioid-exposed infants and their families. In the absence of universal toxicology screening, nurses in the community play an instrumental role in assessing, referring, and supporting these families.
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Affiliation(s)
- Amanda Haas
- University of Saskatchewan - College of Nursing, Saskatoon, Saskatchewan, Saskatchewan.,University of Saskatchewan, Saskatoon, Saskatchewan
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152
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Oostlander SA, Falla JA, Dow K, Fucile S. Occupational Therapy Management Strategies for Infants With Neonatal Abstinence Syndrome: Scoping Review. Occup Ther Health Care 2019; 33:197-226. [PMID: 30987496 DOI: 10.1080/07380577.2019.1594485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With opioid use in North America rising, there is a growing incidence of neonatal abstinence syndrome (NAS). Infants with NAS experience withdrawal signs that interfere with their occupational performance in activities of daily living. This scoping review aims to identify the non-pharmacologic interventions currently used in the treatment of infants with NAS that fall within the scope of the occupational therapy profession. Searching three databases, articles were independently reviewed by two authors to meet defined inclusion criteria. Forty-five articles were included, and the interventions identified and organized according to the Person-Environment-Occupation Model. The non-pharmacologic interventions identified fall within the scope of the occupational therapy profession. Initiating occupational therapy services in an acute care setting may have the potential to improve occupational performance and engagement for these infants from an early age.
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Affiliation(s)
- Samantha A Oostlander
- a Department of Occupational Therapy, School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | - Jillian A Falla
- a Department of Occupational Therapy, School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | - Kimberly Dow
- b Department of Pediatrics/Neonatology , Queen's University , Kingston , ON , Canada
| | - Sandra Fucile
- b Department of Pediatrics/Neonatology , Queen's University , Kingston , ON , Canada
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153
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Oji-Mmuo CN, Speer RR, Gardner FC, Marvin MM, Hozella AC, Doheny KK. Prenatal opioid exposure heightens sympathetic arousal and facial expressions of pain/distress in term neonates at 24-48 hours post birth. J Matern Fetal Neonatal Med 2019; 33:3879-3886. [PMID: 30821185 PMCID: PMC7197408 DOI: 10.1080/14767058.2019.1588876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The rising issue of opioid use during pregnancy poses an increased risk of fetal exposure to opioids in-utero and the development of neonatal abstinence syndrome (NAS). The cessation of exposure to opioids upon birth causes elevated levels of norepinephrine in the circulation enhancing sympathetic arousal. Skin conductance (SC) detects sympathetic-mediated sweating while the Neonatal Facial Coding System (NFCS) depicts facial expressions of stress and pain. We hypothesize that there will be a direct correlation between SC and NFCS scores, such that neonates with prenatal opioid exposure will have higher SC and facial responses to pain/stress as compared with healthy neonates without prenatal opioid exposure.Objective: This study evaluates the utility of SC and the NFCS in the objective assessment of early postnatal pain response in opioid-exposed and non-opioid exposed neonates.Methods: This prospective, single-center, pilot study enrolled opioid-exposed term neonates (>37 weeks) and healthy controls. Subjects were observed within 24-48 hours post-birth (and prior to opioid withdrawal) for pain at baseline, during, and post-heel lance/squeeze (HLS) with simultaneously measured SC and videotaped facial expressions. SC data included electro-dermal responses over time (EDR/second) and the average amplitude of responses (mean of peaks [MP]). Video data were scored using the NFCS by two trained coders with inter-rater agreement >85%.Results: SC and NFCS scores were significantly associated with both groups. The opioid-exposed neonates had significantly higher skin conductance indices, EDR/sec for the HLS phase, and MP for HLS and post phases as compared with controls (p < .05). Opioid-exposed neonates demonstrated higher NFCS at baseline (p = .003).Conclusions: Prenatal opioid exposure was associated with heightened sympathetic arousal during both pain and recovery phases and higher facial expressions of pain/distress at baseline only. A multimodal system of assessment may be useful in understanding the complexity and severity of opioid withdrawal associated with NAS.
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Affiliation(s)
- Christiana N. Oji-Mmuo
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Rebecca R. Speer
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | | | - Megan M. Marvin
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Alexia C. Hozella
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Kim K. Doheny
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA.,Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
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154
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Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience. Pediatr Res 2019; 85:607-611. [PMID: 30287893 PMCID: PMC6435397 DOI: 10.1038/s41390-018-0172-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neonatal abstinence syndrome (NAS) is one of the consequences at birth affecting the newborn after discontinuation of prenatal drug exposure to mainly opioids. The objective of this study was to determine the extent of the problem in the state of West Virginia (WV) using a real-time statewide surveillance system. METHODS Project WATCH is a surveillance tool that since 1998 collects data on all infants born in the state of WV. NAS surveillance item was added to the tool in October 2016. This study examined all births (N = 23,667) in WV from October to December 2017. The data from six WV birthing facilities were audited for 1 month to evaluate how well this tool was capturing NAS data using κ-statistics. RESULTS The 2017 annual incidence rate of NAS was 51.3 per 1000 live births per year for all births and 50.6 per 1000 live births per year for WV residents only. The κ-coefficient between the hospital medical records and Project WATCH data was 0.74 (95% confidence interval: 0.66-0.82) for NAS. CONCLUSION The study provides justification to develop effective systems of care for the mother-infant dyad affected by substance use, especially targeting pregnant women in rural communities.
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155
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Abstract
Neonates exposed prenatally to opioids will often develop a collection of withdrawal signs known as neonatal abstinence syndrome (NAS). The incidence of NAS has substantially increased in recent years placing an increasing burden on the healthcare system. Traditional approaches to assessment and management have relied on symptom-based scoring tools and utilization of slowly decreasing doses of medication, though newer models of care focused on non-pharmacologic interventions and rooming-in have demonstrated promise in reducing length of hospital stay and medication usage. Data on long-term outcomes for both traditional and newer approaches to care of infants with NAS is limited and an important area of future research. This review will examine the history, incidence and pathophysiology of NAS. We will also review diagnostic screening approaches, scoring tools, differing management approaches and conclude with recommendations for continued work to improve the care of infants with NAS.
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Affiliation(s)
- Matthew Grossman
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States.
| | - Adam Berkwitt
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
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156
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Antidepressant use in pregnancy: are we closer to consensus? Arch Womens Ment Health 2019; 22:189-197. [PMID: 30128847 DOI: 10.1007/s00737-018-0906-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 08/10/2018] [Indexed: 01/01/2023]
Abstract
We specify and summarize significant data from recent large studies in a tool with which to aim at consensus on the question of whether and how serotonin-reuptake antidepressants should be used in pregnancy, on the basis that concern for the mental health of the mother should not vie for primacy with concern for the short-, medium-, and long-term health of the child, but must be best served together. Side effects are small but significant over the majority of 11 categories, perinatal and into adolescence. In clinical practice, alternatives for serotonin-reuptake medication in pregnancy should be more actively pursued.
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157
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Abstract
BACKGROUND Perinatal substance exposure is an increasing concern in infants being cared for in neonatal intensive care units. Current recommendations support nonpharmacologic treatments for this population of infants. Multimodal (motion, sound) seats are often employed to soothe infants. PURPOSE The purpose of this study was to survey neonatal intensive care unit nurses on their practices regarding the use of a motion/sound infant seat. METHODS Sixty-six nurses (52% of 126 total nurses) completed the survey about their self-disclosed practices that included (1) reasons for use; (2) rationale for choice of settings of motion and sound; (3) duration of time infants spent in seat in one session; (4) perception of positive infant response; (5) who places infants in the seat; and (6) nursing instructions dispensed prior to use. RESULTS Chief reasons for use were infant state, lack of persons to hold infants, and a diagnosis of neonatal abstinence syndrome. Rationale for choice of motion and sound settings included trial and error, prior settings, personal preferences/patterns, assumptions, and random selection. Nurse responses regarding the amount of time the infant was placed in the seat in a single session ranged from 10 to 360 minutes, with determining factors of infant cues, sleeping, feeding, and someone else to hold the infant. IMPLICATIONS FOR PRACTICE As nonpharmacologic treatments evolve, nurses need guidelines for safe, effective interventions to care for infants. IMPLICATIONS FOR RESEARCH Further research is necessary to ascertain the responses of withdrawing infants and to establish guidelines and education for use of the motion/sound infant seat.
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158
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MacMullen NJ, Samson LF. Neonatal Abstinence Syndrome: An Uncontrollable Epidemic. Crit Care Nurs Clin North Am 2019; 30:585-596. [PMID: 30447815 DOI: 10.1016/j.cnc.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is an uncontrollable epidemic of drug abuse, with the misuse of opioids the most alarming. Along with the increase in opioid abuse, there exists a concomitant upsurge in the number of neonates experiencing neonatal abstinence syndrome (NAS) due to the effects of the mother's withdrawal from the drug. Neonates experiencing NAS exhibit various nervous system, gastrointestinal, and respiratory untoward symptoms. Diagnosis is determined by taking an accurate maternal history and assessment of clinical signs and symptoms. Clinical management strategies include pharmacologic and nonpharmacologic therapies. Nursing care is evidence based, includes nonpharmacologic therapies, and focuses on prevention and support.
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Affiliation(s)
- Nancy J MacMullen
- Department of Nursing, Governors State University, 1 University Parkway, University Park, IL 60484, USA.
| | - Linda F Samson
- Department of Nursing, Governors State University, 1 University Parkway, University Park, IL 60484, USA
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159
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Collier KW, MacAfee LK, Kenny BM, Meyer MC. Does co-location of medication assisted treatment and prenatal care for women with opioid use disorder increase pregnancy planning, length of interpregnancy interval, and postpartum contraceptive uptake? J Subst Abuse Treat 2019; 98:73-77. [DOI: 10.1016/j.jsat.2018.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/02/2018] [Accepted: 12/05/2018] [Indexed: 01/01/2023]
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160
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161
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Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013-2016. Drug Alcohol Depend 2019; 195:156-163. [PMID: 30677745 DOI: 10.1016/j.drugalcdep.2018.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Maternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs. METHODS This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014-2015 (2013-2016) examining health, health care use, treatment, and neonatal outcomes. Diagnosis and procedure codes identify OUD and other substance use disorders (SUDs). RESULTS In the year before and after delivery, 2.2 percent of the sample had an OUD diagnosis, and 5.9 percent had a SUD diagnosis other than OUD. Of the women with OUD, 72.8% had treatment for a SUD in the year before and after delivery, but most had none in an average enrolled month, and only 8.8% received any methadone treatment in a given month. Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other substance use disorders (SUDs). Infants of mothers with OUD did not differ from infants of mothers with other SUDs in rate of preterm or low birth weight but had higher NICU admission rates and longer birth hospitalizations. Health care costs for women with an OUD were higher than those with other SUDs. CONCLUSIONS There is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care. To fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.
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162
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Rose-Jacobs R, Trevino-Talbot M, Lloyd-Travaglini C, Cabral HJ, Vibbert M, Saia K, Wachman EM. Could prenatal food insecurity influence neonatal abstinence syndrome severity? Addiction 2019; 114:337-343. [PMID: 30422365 DOI: 10.1111/add.14458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/03/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS In general populations, prenatal food insecurity negatively affects maternal and infant health. Our aim was to estimate and test the association between prenatal food insecurity and neonatal abstinence syndrome (NAS) severity. DESIGN/SETTING Single-site prospective cohort design. Women receiving opioid agonist treatment with methadone or buprenorphine were interviewed (including demographics and food insecurity) during the third trimester at the combined obstetric/opioid use disorder treatment clinic at Boston Medical Center (BMC) in Boston, MA, USA, a large urban safety-net hospital. During postnatal hospitalization, infants were assessed and treated per hospital NAS protocol. Maternal clinic and infant hospitalization data were abstracted from medical records. PARTICIPANTS Women (n = 75; aged ≥ 18 years; fluent English; singleton pregnancy; intending to deliver at BMC and maintain parental custody) receiving care in the specialized clinic were study eligible (2013-15). Women who delivered infants < 36 weeks gestational age or required prolonged newborn intensive care unit stay were excluded from analyses. PRIMARY MEASUREMENTS Predictors: validated two-question Hunger Vital Sign™ food insecurity screener; outcomes: extent of NAS pharmacological treatment and length of hospital stay (LOS) for NAS. FINDINGS Of the mother-infant dyads, 61 (81%) infants were treated pharmacologically for NAS. Mean hospital LOS was 19.9 (standard deviation = 9.4) days. Maternal food insecurity (n = 43, 57.3%) was associated with infant NAS pharmacological treatment in logistic regression analyses individually adjusted for prenatal: maternal depression [adjusted odds ratios (aOR) = 3.69 (95% confidence intervals (CI) = 1.02-13.43, P = 0.05)] and methadone agonist treatment [aOR = 4.17 (95% CI = 1.05-16.50, P = 0.04)]. Associations of food insecurity and LOS were inconclusive regardless of covariate control (P > 0.05). CONCLUSION Among women receiving opioid agonist treatment, prenatal food insecurity appears to be associated with increased risk for neonatal abstinence syndrome pharmacological treatment.
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Affiliation(s)
- Ruth Rose-Jacobs
- Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | | | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Martha Vibbert
- Pediatrics, Boston University School of Medicine and Boston Medical Center, Mattapan, MA, USA
| | - Kelley Saia
- Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Elisha M Wachman
- Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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163
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Yonke N, Maston R, Weitzen S, Leeman L. Breastfeeding Intention Compared With Breastfeeding Postpartum Among Women Receiving Medication-Assisted Treatment. J Hum Lact 2019; 35:71-79. [PMID: 29723483 DOI: 10.1177/0890334418769637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Women taking methadone or buprenorphine are encouraged to breastfeed if stable without polysubstance use. RESEARCH AIM: We aimed to determine the difference between stated intention to breastfeed prenatally in women taking methadone or buprenorphine compared with breastfeeding at discharge and 2 months postpartum. Secondary outcomes were determining whether breastfeeding was more common in women taking buprenorphine, in women without hepatitis C infection, and in women without a history of heroin use, and whether breastfeeding reduced the need for pharmacological treatment of neonatal opioid withdrawal syndrome. METHODS: This was a retrospective cohort study of 228 women enrolled in a perinatal substance abuse treatment program. Electronic medical records were reviewed to abstract data on mother-infant dyads. Chi-square tests were used to analyze our outcomes. RESULTS: Women taking buprenorphine had a higher prevalence of breastfeeding compared with women taking methadone (83% [ n = 100] vs. 71% [ n = 76]; χ2 = 4.35, p = .03), despite no difference in their prenatal intention to breastfeed (87% vs. 81%; χ2 = 1.28, p = .25). Only 31% ( n = 38) of women taking buprenorphine and 19.6% ( n = 21) of women taking methadone exclusively breastfed at discharge (χ2 = 5.43, p = .06). Exclusively breastfed infants required less pharmacological treatment for neonatal opioid withdrawal syndrome compared with formula-fed infants (15.8% [ n = 21] vs. 47.4% [ n = 38]; χ2 = 19.72, p < .05). CONCLUSION: Despite most women reporting a high prenatal intention to breastfeed, exclusive breastfeeding at hospital discharge postpartum was low. Breastfeeding was associated with a decreased likelihood of pharmacological treatment for neonatal opioid withdrawal syndrome.
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Affiliation(s)
- Nicole Yonke
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rebekah Maston
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Sherry Weitzen
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Lawrence Leeman
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA.,2 Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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164
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Neonatal Abstinence Syndrome (NAS) in Southwestern Border States: Examining Trends, Population Correlates, and Implications for Policy. Matern Child Health J 2019; 22:1352-1359. [PMID: 29572587 DOI: 10.1007/s10995-018-2517-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Neonatal abstinence syndrome (NAS) is withdrawal syndrome in newborns following birth and is primarily caused by maternal drug use during pregnancy. This study examines trends, population correlates, and policy implications of NAS in two Southwest border states. Materials and Methods A cross-sectional analysis of Hospital Inpatient Discharge Data (HIDD) was utilized to examine the incidence of NAS in the Southwest border states of Arizona (AZ) and New Mexico (NM). All inpatient hospital births in AZ and NM from January 1, 2008 through December 31, 2013 with ICD9-CM codes for NAS (779.5), cocaine (760.72), or narcotics (760.75) were extracted. Results During 2008-2013 there were 1472 NAS cases in AZ and 888 in NM. The overall NAS rate during this period was 2.83 per 1000 births (95% CI 2.68-2.97) in AZ and 5.31 (95% CI 4.96-5.66) in NM. NAS rates increased 157% in AZ and 174% in NM. NAS newborns were more likely to have low birth weight, have respiratory distress, more likely to have feeding difficulties, and more likely to be on state Medicaid insurance. AZ border region (border with Mexico) had NAS rates significantly higher than the state rate (4.06 per 1000 births [95% CI 3.68-4.44] vs. 2.83 [95% CI 2.68-2.97], respectively). In NM, the border region rate (2.09 per 1000 births [95% CI 1.48-2.69]) was significantly lower than the state rate (5.31 [95% CI 4.96-5.66]). Conclusions Despite a dramatic increase in the incidence of NAS in the U.S. and, in particular, the Southwest border states of AZ and NM, there is still scant research on the overall incidence of NAS, its assessment in the southwest border, and associated long-term outcomes. The Healthy Border (HB) 2020 binational initiative of the U.S.-Mexico Border Health Commission is an initiative that addresses several public health priorities that not only include chronic and degenerative diseases, infectious diseases, injury prevention, maternal and child health but also mental health and addiction. The growing opioid epidemic and rise in NAS cases in the Southwest border, as partially shown in this study, provides another opportunity to track health illnesses and outcomes in the Southwest border, especially because there are targeted resources through High Intensity Drug Trafficking Areas (HIDTA) funding.
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165
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Liu G, Kong L, Leslie DL, Corr TE. A Longitudinal Healthcare Use Profile of Children with a History of Neonatal Abstinence Syndrome. J Pediatr 2019; 204:111-117.e1. [PMID: 30270164 DOI: 10.1016/j.jpeds.2018.08.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe healthcare use over time of children with a history of neonatal abstinence syndrome (NAS) compared with children without NAS. STUDY DESIGN In this retrospective, longitudinal cohort study, data were obtained from MarketScan Commercial Claims and Encounters database from 2005 to 2014. Children with and without NAS based on International Classification of Diseases, Ninth Revision diagnostic codes were followed until 8 years or disenrollment (mean: 35 months). Numbers of claims for inpatient, outpatient, and emergency department encounters; prescription drugs; and costs associated with these encounters were evaluated. RESULTS Children with NAS had a significantly greater number of claims per year from age 1 to 8 for inpatient hospitalizations (adjusted mean ratio 3.20; 95% CI 1.74-5.90), outpatient encounters (1.23; 1.08-1.41), and emergency department visits (1.46; 1.25-1.70) after we adjusted for confounders. Subsequently, adjusted mean annualized costs were nearly double for all healthcare services in children with NAS (1.86; 1.34-2.60) and >4 times as high as for inpatient hospitalizations (4.34; 2.03-9.30) compared with children without NAS. CONCLUSIONS Children with a diagnosis of NAS have significantly greater rates of healthcare use through age 8 years compared with children without NAS. These findings suggest that children affected by NAS have medical disparities that linger well beyond early infancy.
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Affiliation(s)
- Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA
| | - Tammy E Corr
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Hershey, PA.
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166
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Tsai SYA, Bendriem RM, Lee CTD. The cellular basis of fetal endoplasmic reticulum stress and oxidative stress in drug-induced neurodevelopmental deficits. Neurobiol Stress 2018; 10:100145. [PMID: 30937351 PMCID: PMC6430408 DOI: 10.1016/j.ynstr.2018.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 12/02/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022] Open
Abstract
Prenatal substance exposure is a growing public health concern worldwide. Although the opioid crisis remains one of the most prevalent addiction problems in our society, abuse of cocaine, methamphetamines, and other illicit drugs, particularly amongst pregnant women, are nonetheless significant and widespread. Evidence demonstrates prenatal drug exposure can affect fetal brain development and thus can have long-lasting impact on neurobehavioral and cognitive performance later in life. In this review, we highlight research examining the most prevalent drugs of abuse and their effects on brain development with a focus on endoplasmic reticulum stress and oxidative stress signaling pathways. A thorough exploration of drug-induced cellular stress mechanisms during prenatal brain development may provide insight into therapeutic interventions to combat effects of prenatal drug exposure.
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Affiliation(s)
- S-Y A Tsai
- Integrative Neuroscience Branch, Division of Neuroscience and Behavior, National Institute on Drug Abuse, The National Institute of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA
| | - Raphael M Bendriem
- Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Chun-Ting D Lee
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, USA
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167
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Abstract
Objective: To summarize the available data for using buprenorphine in neonatal abstinence syndrome and discuss these data in context of the current standard of care therapies, oral morphine and oral methadone. Data Sources: A literature search was conducted using PubMed (1949-May 2018) and EMBASE (1980-May 2018). Combinations of the search terms “buprenorphine,” “neonatal,” and “neonatal abstinence syndrome” were used. Study Selection and Data Extraction: All full-length, English-language studies were included in this review. Data Synthesis: A total of 4 studies were included in this review including 1 retrospective cohort study, 2 prospective single-center open-label randomized trials, and 1 prospective single-center, double-blind study. Oral morphine was the comparator in 3 studies, and oral methadone was the comparator in one. Buprenorphine was associated with a significant reduction in duration of treatment in 3 of the 4 studies and was associated with a significant reduction in duration of hospital stay in 3 of the 4 studies. In the randomized, double-blinded trial, buprenorphine had a significantly reduced duration of treatment (15 vs 28 days, P < .001) and duration of hospital stay (21 vs 33 days, P < .001). The requirement of adjunct treatment was similar between groups in all 4 studies, and buprenorphine did not have any significant adverse reactions in comparison with morphine and methadone. Conclusions: Buprenorphine appears to be a safe option for treating neonatal abstinence syndrome that is potentially superior to the current standard of care therapies with respect to duration of treatment and hospital length of stay.
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168
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Bailey NA, Diaz-Barbosa M. Effect of Maternal Substance Abuse on the Fetus, Neonate, and Child. Pediatr Rev 2018; 39:550-559. [PMID: 30385584 DOI: 10.1542/pir.2017-0201] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nicole A Bailey
- Division of Neonatology, Kidz Medical Services, Coral Gables, FL.,Division of Neonatology, Nicklaus Children's Hospital/Florida International University School of Medicine, Miami, FL
| | - Magaly Diaz-Barbosa
- Division of Neonatology, Kidz Medical Services, Coral Gables, FL.,Division of Neonatology, Nicklaus Children's Hospital/Florida International University School of Medicine, Miami, FL
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Kvello AMS, Andersen JM, Øiestad EL, Steinsland S, Aase A, Mørland J, Bogen IL. A Monoclonal Antibody against 6-Acetylmorphine Protects Female Mice Offspring from Adverse Behavioral Effects Induced by Prenatal Heroin Exposure. J Pharmacol Exp Ther 2018; 368:106-115. [PMID: 30361238 DOI: 10.1124/jpet.118.251504] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/22/2018] [Indexed: 01/04/2023] Open
Abstract
Escalating opioid use among fertile women has increased the number of children being exposed to opioids during fetal life. Furthermore, accumulating evidence links prenatal opioid exposure, including opioid maintenance treatment, to long-term negative effects on cognition and behavior, and presses the need to explore novel treatment strategies for pregnant opioid users. The present study examined the potential of a monoclonal antibody (mAb) targeting heroin's first metabolite, 6-acetylmorphine (6-AM), in providing fetal protection against harmful effects of prenatal heroin exposure in mice. First, we examined anti-6-AM mAb's ability to block materno-fetal transfer of active metabolites after maternal heroin administration. Next, we studied whether maternal mAb pretreatment could prevent adverse effects in neonatal and adolescent offspring exposed to intrauterine heroin (3 × 1.05 mg/kg). Anti-6-AM mAb pretreatment of pregnant dams profoundly reduced the distribution of active heroin metabolites to the fetal brain. Furthermore, maternal mAb administration prevented hyperactivity and drug sensitization in adolescent female offspring prenatally exposed to heroin. Our findings demonstrate that passive immunization with a 6-AM-specific antibody during pregnancy provides fetal neuroprotection against heroin metabolites, and thereby prevents persistent adverse behavioral effects in the offspring. An immunotherapeutic approach to protect the fetus against long-term effects of prenatal drug exposure has not been reported previously, and should be further explored as prophylactic treatment of pregnant heroin users susceptible to relapse.
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Affiliation(s)
- Anne Marte Sjursen Kvello
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Jannike Mørch Andersen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Elisabeth Leere Øiestad
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Synne Steinsland
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Audun Aase
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Jørg Mørland
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Lise Bogen
- Section for Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway (A.M.S.K., J.M.A., E.L.Ø., S.S., I.L.B.); School of Pharmacy, Faculty of Mathematics and Natural Sciences (A.M.S.K., J.M.A., E.L.Ø.), Institute of Basic Medical Sciences (I.L.B.) and Institute of Clinical Medicine (J.M.), Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Infectious Disease Immunology (A.A.) and Department of Health Data and Digitalization (J.M.), Norwegian Institute of Public Health, Oslo, Norway
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170
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Marcellus L. Neonatal abstinence syndrome in countries with no to low medical opioid consumption: a scoping review. Int Nurs Rev 2018; 66:224-233. [PMID: 30318821 DOI: 10.1111/inr.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To describe the current state of evidence on the care of neonates with neonatal abstinence syndrome in countries with low to virtually no medical opioid analgesic consumption. BACKGROUND While access to opioids for medical use improves globally, misuse grows as a health concern. One unintended consequence has been an increase in the incidence of neonatal abstinence syndrome. Because most evidence is generated in countries with adequate opioid analgesic consumption, a picture of evidence in lower opioid-consuming countries is not available. DESIGN A scoping review methodology was employed and augmented with principles of international development literature review. Electronic database searches (PubMed and CINAHL) located 1106 articles. Google was employed to access an additional 17 non-indexed articles. From the total of 1123 articles located, 27 articles from 15 countries were included. RESULTS Minimal evidence was produced in low to virtually no medical opioid-consuming countries. Sources were primarily review articles, descriptive, comparative or case reports. Seventy-one per cent of the articles identified at least one specific clinical practice related to the care of infants with neonatal abstinence syndrome. CONCLUSIONS As opioid analgesic use increases globally, a subsequent increase in neonatal abstinence syndrome is likely. It will be beneficial for providers and policymakers to be proactive in considering implications for neonatal and maternal populations and collaborate with providers who have been gaining experience in this area. A number of these countries are heroin-growing regions and already experiencing issues. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY Policymakers may use these findings to support data collection and reporting, context and resource relevant guideline development, and advocacy for inclusion of the maternal-infant population in global opioid research priority setting. International collaboration for establishing gender and culturally appropriate practices globally is critical.
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Affiliation(s)
- L Marcellus
- School of Nursing, University of Victoria, Victoria, BC, Canada
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171
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Byrnes EM, Vassoler FM. Modeling prenatal opioid exposure in animals: Current findings and future directions. Front Neuroendocrinol 2018; 51:1-13. [PMID: 28965857 PMCID: PMC5649358 DOI: 10.1016/j.yfrne.2017.09.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 01/03/2023]
Abstract
The past decade has seen a drastic rise in the number of infants exposed to opioids in utero. It is unclear what lasting effect this exposure may have on these children. Animal models of prenatal opioid exposure may provide insight into potential areas of vulnerability. The present review summarizes the findings across animal models of prenatal opioid exposure, including exposure to morphine, methadone, buprenorphine, and oxycodone. Details regarding the drug, doses, and duration of treatment, as well as key findings, are summarized in tables with associated references. Finally, significant gaps in the current preclinical literature and future directions are discussed.
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Affiliation(s)
- Elizabeth M Byrnes
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, United States.
| | - Fair M Vassoler
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, United States
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172
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Maguire DJ, Shaffer-Hudkins E, Armstrong K, Clark L. Feeding Infants with Neonatal Abstinence Syndrome: Finding the Sweet Spot. Neonatal Netw 2018; 37:11-18. [PMID: 29436353 DOI: 10.1891/0730-0832.37.1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal. DESIGN/SAMPLE Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended. RESULTS Four major themes emerged verified by the participants: (1) optimal medication management, (2) follow the baby's cues, (3) calm and comfortable, and (4) nurture the relationship. Participants reported using both common and creative techniques. Keeping the infant calm was crucial to being successful, as well as maintaining good control of withdrawal signs. Feeding the infant facing away from them to avoid eye contact was used, as well as vertical rocking, continuous butt patting, bundling, "shhing" sound, and a novel feeding position.
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173
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McGlothen KS, Cleveland LM, Gill SL. "I'm Doing the Best That I Can for Her": Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder. J Hum Lact 2018; 34:535-542. [PMID: 29324188 DOI: 10.1177/0890334417745521] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several professional health organizations have made statements endorsing the safety of breastfeeding for women taking medication-assisted treatment for an opioid use disorder. Yet, breastfeeding initiation rates for this population are approximately 50% lower than the general United States' population. Furthermore, little is known about what influences the infant-feeding decisions of these women. Research aim: This study aimed to describe what influences the infant-feeding decisions of women taking medication-assisted treatment for an opioid use disorder. METHODS Qualitative description was used. We conducted semistructured, individual interviews with mothers ( N = 8) who were receiving medication-assisted treatment during the postpartum period. We analyzed our data using thematic analysis. RESULTS We identified two themes: (a) what I heard about breastfeeding, and (b) doing what I feel is best for my baby. What I heard about breastfeeding reflects the information and misinformation that women received about breastfeeding. Doing what I feel is best for my baby describes the inner conflict that the women experienced. Most of the women in this study desired to breastfeed; however, all women reported that the social stigma surrounding methadone use strongly influenced their infant-feeding decision. CONCLUSION This study sheds new light on what influences the infant-feeding decisions of women taking medication-assisted treatment and represents an initial step toward the development of targeted interventions to improve breastfeeding rates for this unique population.
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Affiliation(s)
- Kelly S McGlothen
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lisa M Cleveland
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sara L Gill
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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174
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Kramlich D, Kronk R, Marcellus L, Colbert A, Jakub K. Rural Postpartum Women With Substance Use Disorders. QUALITATIVE HEALTH RESEARCH 2018; 28:1449-1461. [PMID: 29651928 DOI: 10.1177/1049732318765720] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.
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Affiliation(s)
| | - Rebecca Kronk
- 1 Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | | | - Karen Jakub
- 1 Duquesne University, Pittsburgh, Pennsylvania, USA
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175
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Marcellus L. Social Ecological Examination of Factors That Influence the Treatment of Newborns With Neonatal Abstinence Syndrome. J Obstet Gynecol Neonatal Nurs 2018; 47:509-519. [DOI: 10.1016/j.jogn.2018.04.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 10/28/2022] Open
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176
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Abstract
The incidence of opioid abuse and subsequent drug withdrawal is exponentially on the rise in the United States for many populations including newborns who are born to drug-addicted mothers. These newborns often exhibit symptoms of neonatal abstinence syndrome (NAS) within 24 to 72 hours of birth. Treatment of NAS includes monitoring of withdrawal symptoms, managing physiological parameters, and the use of supportive and pharmacologic treatments. Although a few randomized controlled trials exist, studies on supportive intervention are generally limited by small sample sizes, case study reports, expert opinions, and descriptive design. Few studies address the safety of Reiki for newborns at risk for NAS using neonatal parameters. This pilot study addresses feasibility and demonstrates that Reiki is safe when administered to this high-risk population. Considerations for future studies are discussed.
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177
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Hall ES, McAllister JM, Wexelblatt SL. Developmental Disorders and Medical Complications Among Infants with Subclinical Intrauterine Opioid Exposures. Popul Health Manag 2018; 22:19-24. [PMID: 29893624 DOI: 10.1089/pop.2018.0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objective was to compare diagnosis rates representing developmental outcomes and medical complications between infants with intrauterine opioid exposures who did not receive pharmacologic treatment for neonatal abstinence syndrome at the time of birth and infants for whom no exposure to substances of abuse were detected. This retrospective, descriptive study included approximately 95% of Hamilton County, Ohio resident births in 2014 and 2015. Universal maternal drug test results, performed at the time of birth, were documented and linked to electronic health records representing pediatric primary and subspecialty follow-up care as well as urgent care, emergency care, and inpatient services provided by Cincinnati Children's Hospital Medical Center through 2017, when all children were at least 24 months old. Diagnosis rates were compared between drug exposure groups using chi-square tests. Among infants born at >34 weeks gestation and without other complex clinical conditions, infants with subclinical opioid exposures (N = 473) were more likely than infants with no drug exposures (N = 14,933) to be diagnosed with behavioral or emotional disorders (3.0% vs 1.1%, P = 0.0008), developmental delay (15.6% vs 7.6%, P < 0.0001), speech disorder (10.1% vs 6.5%, P = 0.001), or strabismus (3.4% vs 1.0%, P < 0.0001), and more likely to be exposed to the hepatitis C virus (6.8% vs 0.1%, P < 0.0001). Increased diagnosis rates among all opioid exposed infants, regardless of withdrawal severity, may warrant the additional allocation of resources for screening and follow-up. Awareness of the increased risk for certain developmental delays and medical conditions is critical to early intervention and treatment supporting improved outcomes.
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Affiliation(s)
- Eric S Hall
- 1 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio.,2 Perinatal Institute , Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,3 Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Jennifer M McAllister
- 1 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio.,2 Perinatal Institute , Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott L Wexelblatt
- 1 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio.,2 Perinatal Institute , Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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178
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179
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Management of Neonatal Abstinence Syndrome: The Importance of a Multifaceted Program Spanning Inpatient and Outpatient Care. Jt Comm J Qual Patient Saf 2018; 44:309-311. [DOI: 10.1016/j.jcjq.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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180
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Allen N, Prunty L, Babcock C'CK', Attarabeen O, Patel I. Non-pharmacological interventions for neonatal abstinence syndrome. Addiction 2018; 113:1750-1751. [PMID: 29797741 DOI: 10.1111/add.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Noah Allen
- Marshall University School of Pharmacy, Huntington, WV, USA
| | - Leesa Prunty
- University Hospitals Rainbow Babies and Children Hospital, University Hospitals Home Care Services, Cleveland, OH, USA
| | - Charles ' C K ' Babcock
- Department of Pharmacy Practice, Research, and Administration, Huntington, WV, USA
- School of Pharmacy, Marshall University, USA
| | | | - Isha Patel
- Department of Pharmacy Practice, Research, and Administration, Huntington, WV, USA
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181
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Lacaze-Masmonteil T, O’Flaherty P. La prise en charge des nouveau-nés dont la mère a pris des opioïdes pendant la grossesse. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxx200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Pat O’Flaherty
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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182
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Lacaze-Masmonteil T, O'Flaherty P. Managing infants born to mothers who have used opioids during pregnancy. Paediatr Child Health 2018; 23:220-226. [PMID: 29769809 DOI: 10.1093/pch/pxx199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment. This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency.
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Affiliation(s)
| | - Pat O'Flaherty
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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183
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Abstract
Aim The purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). Background NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid exposure in utero. Infants requiring pharmacologic treatment to manage withdrawal, traditionally receive treatment as a hospital inpatient resulting in lengthy hospitalization periods. However, there is evidence to suggest that some healthcare institutions are continuing outpatient pharmacologic weaning for select infants in a home environment. As there is no standard of care to guide outpatient weaning, assessment of the safety and effectiveness of this approach is warranted. Method A systematic review of outpatient weaning for infants with NAS was conducted using the electronic databases PubMed, Nursing and Allied Health, CINAHL, Evidence-Based Medicine, Web of Science, Medline, and PsychINFO. Studies were eligible for inclusion in the review if they fulfilled the following criteria: (1) reported original data on outcomes related to the effectiveness or safety of outpatient weaning for infants with NAS, (2) infants were discharged from hospital primarily receiving opioid pharmacologic treatment for NAS, (3) the method included quantitative designs that included an inpatient comparison group, and (4) articles were published in English in a peer-reviewed journal. Findings The search identified 154 studies, of which 18 provided information related to NAS and outpatient weaning. After reviewing the remaining full-text studies, six studies met all inclusion and exclusion criteria. All studies identified that outpatient weaning for select infants was associated with shorter hospitalization compared with infants weaned in-hospital only and may be potentially effective in reducing associated healthcare costs. However, duration of pharmacologic treatment was longer in the outpatient weaning groups in the majority of the studies. Furthermore, adverse events were rare and compliance to follow-up treatment was high among those who received outpatient weaning.
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184
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Busch D, Silbert-Flagg J. Opioid Use Dependency in the Mother Who Desires to Breastfeed Her Newborn: A Case Study. J Pediatr Health Care 2018; 32:223-230. [PMID: 29291904 DOI: 10.1016/j.pedhc.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/25/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
The number of infants born to mothers with opioid dependence is increasing at an alarming rate, indicating a 5-fold increase for women using opiates and a 3-fold increase in infants born with neonatal abstinence syndrome (NAS; Tsai & Doan, 2016 ). Pediatric Nurse Practitioners providing primary care, who lack experience with this clinical presentation, require evidence-based knowledge to provide the appropriate care to infants born with neonatal abstinence syndrome. Mothers with opioid dependence often desire to breastfeed their newborns, and the PNP may unknowingly discourage them from breastfeeding. In this case discussion, we describe how breastfeeding is possible and is beneficial. Current evidence-based practice recommendations and resources are included demonstrating that human breast milk has the potential to substantially improve health outcomes for all mothers and their newborns, especially this unique dyad (Tsai & Doan, 2016; Reece-Stremtan & Marinelli, 2015).
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185
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Falletta L, Hamilton K, Fischbein R, Aultman J, Kinney B, Kenne D. Perceptions of child protective services among pregnant or recently pregnant, opioid-using women in substance abuse treatment. CHILD ABUSE & NEGLECT 2018; 79:125-135. [PMID: 29433069 DOI: 10.1016/j.chiabu.2018.01.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/30/2018] [Indexed: 05/21/2023]
Abstract
Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of inter-rater reliability. Following 2, two-hour meetings, consensus was reached on primary themes and sub-themes. Two major themes and several sub-themes were identified: 1) Participants' feelings and attitudes about CPS (positive and negative); 2) Interaction-based perceptions of CPS' function and performance. Participants' feelings toward CPS were often conditioned by their experiences with individual caseworkers. While many pregnant, opioid-using women identify legitimate, and even useful features of CPS, fear of CPS can be a barrier to care. Making substance abuse treatment accessible to this population requires recognition of their complex feelings toward CPS, and coordination among CPS case workers and substance abuse treatment providers.
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Affiliation(s)
- Lynn Falletta
- College of Public Health, Kent State University, 750 Hilltop Drive, P.O. Box 5190, Kent, OH 44242, United States.
| | - Kelsey Hamilton
- College of Public Health, Kent State University, 750 Hilltop Drive, P.O. Box 5190, Kent, OH 44242, United States.
| | - Rebecca Fischbein
- Northeast Ohio Medical University, 4209 State Route 44, P.O. Box 95, Rootstown, OH 44272, United States.
| | - Julie Aultman
- Northeast Ohio Medical University, 4209 State Route 44, P.O. Box 95, Rootstown, OH 44272, United States.
| | - Beth Kinney
- Summit County Children Services, 264 South Arlington Street, Akron, OH 44306, United States.
| | - Deric Kenne
- College of Public Health, Kent State University, 750 Hilltop Drive, P.O. Box 5190, Kent, OH 44242, United States.
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187
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Winkelman TN, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004 -2014. Pediatrics 2018; 141:peds.2017-3520. [PMID: 29572288 PMCID: PMC5869343 DOI: 10.1542/peds.2017-3520] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe incidence, health care use, and cost trends for infants with neonatal abstinence syndrome (NAS) who are covered by Medicaid compared with other infants. METHODS We used 2004-2014 hospital birth data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States (N = 13 102 793). Characteristics and trends among births impacted by NAS were examined by using univariate statistics and logistic regression. RESULTS Medicaid covered 73.7% of NAS-related births in 2004 (95% confidence interval [CI], 68.9%-77.9%) and 82.0% of NAS-related births in 2014 (95% CI, 80.5%-83.5%). Among infants covered by Medicaid, NAS incidence increased more than fivefold during our study period, from 2.8 per 1000 births (95% CI, 2.1-3.6) in 2004 to 14.4 per 1000 births (95% CI, 12.9-15.8) in 2014. Infants with NAS who were covered by Medicaid were significantly more likely to be transferred to another hospital and have a longer length of stay than infants without NAS who were enrolled in Medicaid or infants with NAS who were covered by private insurance. Adjusting for inflation, total hospital costs for NAS births that were covered by Medicaid increased from $65.4 million in 2004 to $462 million in 2014. The proportion of neonatal hospital costs due to NAS increased from 1.6% in 2004 to 6.7% in 2014 among births that were covered by Medicaid. CONCLUSIONS The number of Medicaid-financed births that are impacted by NAS has risen substantially and totaled $462 million in hospital costs in 2014. Improving affordable health insurance coverage for low-income women before pregnancy would expand access to substance use disorder treatment and could reduce NAS-related morbidity and costs.
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Affiliation(s)
- Tyler N.A. Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota;,Center for Patient and Provider Experience, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Nicole Villapiano
- Family Health Network, Cortland Regional Medical Center, Cortland, New York
| | - Katy B. Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Matthew M. Davis
- Mary Ann & J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois;,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Stephen W. Patrick
- Departments of Pediatrics and,Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee
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188
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MacMillan KDL, Rendon CP, Verma K, Riblet N, Washer DB, Volpe Holmes A. Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. JAMA Pediatr 2018; 172:345-351. [PMID: 29404599 PMCID: PMC5875350 DOI: 10.1001/jamapediatrics.2017.5195] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Rising incidence of neonatal abstinence syndrome (NAS) is straining perinatal care systems. Newborns with NAS traditionally receive care in neonatal intensive care units (NICUs), but rooming-in with mother and family has been proposed to reduce the use of pharmacotherapy, length of stay (LOS), and cost. OBJECTIVE To systematically review and meta-analyze if rooming-in is associated with improved outcomes for newborns with NAS. DATA SOURCES MEDLINE, CINAHL, The Cochrane Library, and clinicaltrials.gov were searched from inception through June 25, 2017. STUDY SELECTION This investigation included randomized clinical trials, cohort studies, quasi-experimental studies, and before-and-after quality improvement investigations comparing rooming-in vs standard NICU care for newborns with NAS. DATA EXTRACTION AND SYNTHESIS Two independent investigators reviewed studies for inclusion. A random-effects model was used to pool dichotomous outcomes using risk ratio (RR) and 95% CI. The study evaluated continuous outcomes using weighted mean difference (WMD) and 95% CI. MAIN OUTCOMES AND MEASURES The primary outcome was newborn treatment with pharmacotherapy. Secondary outcomes included LOS, inpatient cost, and harms from treatment, including in-hospital adverse events and readmission rates. RESULTS Of 413 publications, 6 studies (n = 549 [number of patients]) met inclusion criteria. In meta-analysis of 6 studies, there was consistent evidence that rooming-in is preferable to NICU care for reducing both the use of pharmacotherapy (RR, 0.37; 95% CI, 0.19-0.71; I2 = 85%) and LOS (WMD, -10.41 days; 95% CI, -16.84 to -3.98 days; I2 = 91%). Sensitivity analysis resolved the heterogeneity for the use of pharmacotherapy, significantly favoring rooming-in (RR, 0.32; 95% CI, 0.18-0.57; I2 = 13%). Three studies reported that inpatient costs were lower with rooming-in; however, significant heterogeneity precluded quantitative analysis. Qualitative analysis favored rooming-in over NICU care for increasing breastfeeding rates and discharge home in familial custody, but few studies reported on these outcomes. Rooming-in was not associated with higher rates of readmission or in-hospital adverse events. CONCLUSIONS AND RELEVANCE Opioid-exposed newborns rooming-in with mother or other family members appear to be significantly less likely to be treated with pharmacotherapy and have substantial reductions in LOS compared with those cared for in NICUs. Rooming-in should be recommended as a preferred inpatient care model for NAS.
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Affiliation(s)
- Kathryn Dee L. MacMillan
- Leadership Preventive Medicine Residency, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Cassandra P. Rendon
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kanak Verma
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Natalie Riblet
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - David B. Washer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Alison Volpe Holmes
- Leadership Preventive Medicine Residency, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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189
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Sandtorv LB, Fevang SKE, Nilsen SA, Bøe T, Gjestad R, Haugland S, Elgen IB. Symptoms Associated With Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorders in School-Aged Children Prenatally Exposed to Substances. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2018; 12:1178221818765773. [PMID: 29618930 PMCID: PMC5871041 DOI: 10.1177/1178221818765773] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/26/2018] [Indexed: 12/27/2022]
Abstract
Prenatal exposure to substances may influence a child's neurodevelopment and impact on subsequent mental health. In a hospital-based population of school-aged children prenatally exposed to opiates and a number of illicit substances (n = 57), we evaluated mental health symptoms associated with attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) using the Swanson, Nolan, and Pelham Questionnaire, revision IV (SNAP-IV) and the Autism Spectrum Screening Questionnaire (ASSQ) and compared the scores to a reference group which comprised children from the population-based Bergen Child Study (n = 171). Prenatally exposed children had significantly higher SNAP-IV scores associated with ADHD symptoms in both areas of inattention and hyperactivity/impulsivity and also reported a higher ASSQ score related to an increased number of symptoms associated with ASD, compared with the reference group. Of tested predictors of mental health outcomes in the exposed group, the intelligence quotient was a strong predictor of most mental health outcomes, and neonatal abstinence syndrome was a predictor of inattention. In conclusion, prenatally exposed children had more mental health symptoms associated with ADHD and ASD, compared with the reference group.
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Affiliation(s)
- Lisbeth Beate Sandtorv
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Rolf Gjestad
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Siren Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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190
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Allegaert K, Smits A, van den Anker JN. Drug evaluation studies in neonates: how to overcome the current limitations. Expert Rev Clin Pharmacol 2018; 11:387-396. [PMID: 29421929 DOI: 10.1080/17512433.2018.1439378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Regulatory initiatives have stimulated drug research in infants, but the potential impact of drugs to improve health outcome in neonates remains underexplored. Areas covered: In this review, we focus on current limitations in drug evaluation studies and how to overcome these. The low volume of studies has additional weaknesses such as single center studies, non-commercial sponsorship, overrepresentation of high postulated risk reductions, and underrepresentation of therapeutic exploratory studies. Master protocols and selection criteria for neonatal centers to participate in studies are useful to improve logistics related to performance. Limitations also relate to inaccurate assessment of drug effects (efficacy/safety). This is because of poor symptom recognition, case definitions, and suboptimal data on adverse drug reactions (ADRs) epidemiology. To overcome these limitations, it is necessary to develop core outcome sets, reference values, and specific ADR tools. The limitations identified and approaches suggested to improve drug evaluation are illustrated using neonatal abstinence syndrome as an example. Expert commentary: We anticipate to see an evolving neonatal clinical pharmacology discipline driven by neonatal pathophysiology and knowledge. Multidisciplinary collaborative efforts between health care providers, academia, pharmaceutical industry, advocacy groups and regulatory agencies are crucial to improve the impact of drug evaluation studies in neonates.
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Affiliation(s)
- Karel Allegaert
- a Department of Development and Regeneration , KU Leuven , Leuven , Belgium.,b Intensive Care and Department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands
| | - Anne Smits
- c Neonatal intensive care unit , University Hospitals Leuven , Leuven , Belgium
| | - John N van den Anker
- b Intensive Care and Department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.,d Division of Clinical Pharmacology, Department of Pediatrics , Children's National Health System , Washington, DC , USA.,e Division of Paediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland
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191
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Uusküla A, Raag M, Vorobjov S, Jarlais DD. Another frontier for harm reduction: contraceptive needs of females who inject drugs in Estonia, a cross-sectional study. Harm Reduct J 2018; 15:10. [PMID: 29506538 PMCID: PMC5838942 DOI: 10.1186/s12954-018-0215-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/21/2018] [Indexed: 01/04/2023] Open
Abstract
Background Despite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception. Methods In a series of cross-sectional studies (2007–2013), 265 current FWID were recruited through respondent-driven sampling (RDS), interviewed, and tested for HIV. RDS weights were used to estimate the prevalence of effective contraception (hormonal contraception, intrauterine device, sterilization) use in the last 6 months. Results Of the sexually active women with main partners (n = 196) 4.8% (95% CI 2.3–9.7) were using effective contraception, 52.7% (95% CI 42.5–62.7) less-effective or no contraception. 42.5% (95% CI 32.7–52.9) relied on condoms for contraception. The odds for using effective contraception were higher among women with > 10 years of education (OR 7.29, 95% CI 1.4–38.8). None of the women lacking health insurance (n = 84) were using effective contraception. Conclusions The very low coverage with effective contraception highlights the need to improve contraceptive services for FWID. Reproductive health service including contraception should be considered essential components of harm reduction and of comprehensive prevention and care for HIV among persons who use drugs.
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Affiliation(s)
- Anneli Uusküla
- Department of Family medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Mait Raag
- Department of Family medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Sigrid Vorobjov
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Tallinn, Estonia
| | - Don Des Jarlais
- Department of Psychiatry, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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192
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Haycraft AL. Pregnancy and the Opioid Epidemic. J Psychosoc Nurs Ment Health Serv 2018; 56:19-23. [PMID: 29505087 DOI: 10.3928/02793695-20180219-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/24/2018] [Indexed: 11/20/2022]
Abstract
Opioid use disorder (OUD) in pregnancy is increasing, which often results in poor maternal and neonatal outcomes including neonatal abstinence syndrome (NAS) as a result of lack of prenatal care and inadequate substance use disorder management. Practice guidelines have been developed to manage OUD during and after pregnancy for mother and baby, but barriers exist, limiting comprehensive implementation. To reduce the impact of OUD in pregnancy and associated maternal and neonatal sequela, implementing compassionate evidence-based care and a non-punitive response is needed. A stigma-free approach, substance use disorder screening, medication-assisted treatment, screening and treatment of mental health disorders, and an after-birth environment that promotes maternal-child bonding are recommended. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 19-23.].
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193
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Nienaber TA, James RK, Burke BL, Beavers J. Can Neonates Get the Munchies? Clin Pediatr (Phila) 2018; 57:358-360. [PMID: 28952342 DOI: 10.1177/0009922817694460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas A Nienaber
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
| | - Ryan K James
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
| | - Bryan L Burke
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
| | - Jessica Beavers
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
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194
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Hall ES, Wexelblatt SL, Greenberg JM. Surveillance of Intrauterine Opioid Exposures Using Electronic Health Records. Popul Health Manag 2018; 21:486-492. [PMID: 29485940 DOI: 10.1089/pop.2017.0184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The objective was to use population-based electronic health records for surveillance of intrauterine exposures to substances of abuse, including opioids, and to monitor changes in exposure rates over time. This retrospective, descriptive analysis utilized geocoded neonatal physician billing records representing intrauterine exposures to substances of abuse detected through universal maternal drug testing. Census tract-level exposure rates were identified among the newborn population of Hamilton County, Ohio between 2014 and 2016. Among 27,896 newborns, the authors detected an intrauterine opioid exposure rate of 37.9 per 1000 infants, with 10.5 per 1000 experiencing severe opioid withdrawal (neonatal abstinence syndrome). Individual data were mapped to 222 US census tracts. Tract-level opioid exposure rates ranged from 0.0 to 607.1 (median: 32.9) per 1000 live births. Secondary use of electronic health record data has potential to aid in intrauterine opioid exposure and other public health surveillance efforts without disrupting clinical workflows or placing an additional burden on limited resources. Surveillance of intrauterine opioid exposures may inform stakeholders and enable targeting of interventions and prevention strategies toward the highest risk populations.
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Affiliation(s)
- Eric S Hall
- 1 Perinatal Institute, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,2 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio.,3 Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Scott L Wexelblatt
- 1 Perinatal Institute, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,2 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - James M Greenberg
- 1 Perinatal Institute, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,2 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio
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195
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Gomez-Pomar E, Finnegan LP. The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its' Origins, Assessment, and Management. Front Pediatr 2018; 6:33. [PMID: 29520355 PMCID: PMC5827164 DOI: 10.3389/fped.2018.00033] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
Neonatal abstinence syndrome (NAS) refers to a constellation of signs that are present in some newborn infants resulting from the abrupt cessation of passive transfer of maternal opioids used during pregnancy. The classic NAS refers to infants born to mothers who used opioids during pregnancy, but the term has broadened to include infants whose mothers have used or abused other psychoactive substances during pregnancy that contribute to the expression of the syndrome. Pregnant women who use opioids do so illicitly, and/or as medically prescribed for pain relief, and/or as medication assisted treatment for opioid dependence. The first case of NAS in infants and the subsequent treatment (or lack thereof) was reported in 1875 and was called Congenital Morphinism. By 2012, the incidence of NAS increased to more than 30 per 1,000 hospital live births, along with an increase in the number of infants being treated pharmacologically for NAS, resulting in an increase in the length of stay and healthcare expenses. We present historical references on NAS, the various factors and events that led to its increasing prevalence and today's current epidemic. We also review the current tools to assess infants with NAS and treatment options in its management.
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Affiliation(s)
- Enrique Gomez-Pomar
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Loretta P. Finnegan
- The College on Problems of Drug Dependence, Inc., Philadelphia, PA, United States
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196
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The Clinical Presentation and Nutritional Management of an Infant With Neonatal Abstinence Syndrome. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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197
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Wexelblatt SL, McAllister JM, Nathan AT, Hall ES. Opioid Neonatal Abstinence Syndrome: An Overview. Clin Pharmacol Ther 2017; 103:979-981. [PMID: 29285767 DOI: 10.1002/cpt.958] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/07/2017] [Accepted: 11/28/2017] [Indexed: 11/08/2022]
Abstract
Opioid neonatal abstinence syndrome (NAS) refers to signs of withdrawal observed in infants experiencing intrauterine opioid exposures. Early identification of at-risk infants allows for the prompt initiation of nonpharmacologic supportive care. When withdrawal symptoms are severe despite these interventions, pharmacologic therapy including opioid weaning is initiated. Consistency with standardized nonpharmacologic approaches as well as stringent weaning protocols are important in minimizing the length of stay and length of pharmacologic treatment for these vulnerable patients.
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Affiliation(s)
- Scott L Wexelblatt
- Cincinnati Children's Hospital Medical Center, Division of Neonatology, Cincinnati, Ohio, USA
| | - Jennifer M McAllister
- Cincinnati Children's Hospital Medical Center, Division of Neonatology, Cincinnati, Ohio, USA
| | - Amy T Nathan
- Cincinnati Children's Hospital Medical Center, Division of Neonatology, Cincinnati, Ohio, USA
| | - Eric S Hall
- Cincinnati Children's Hospital Medical Center, Division of Neonatology, Cincinnati, Ohio, USA
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198
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Ohler KH, Pham JT. The Effect of Morphine Dosing on Length of Stay in Neonatal Abstinence Syndrome - An Alternative Viewpoint. Pharmacotherapy 2017; 37:e122-e123. [DOI: 10.1002/phar.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kirsten H. Ohler
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Children's Hospital University of Illinois; University of Illinois Hospital & Health Sciences System; Chicago Illinois
| | - Jennifer T. Pham
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Children's Hospital University of Illinois; University of Illinois Hospital & Health Sciences System; Chicago Illinois
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199
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Fenn NE, Plake KS. Opioid and Benzodiazepine Weaning in Pediatric Patients: Review of Current Literature. Pharmacotherapy 2017; 37:1458-1468. [PMID: 28891099 DOI: 10.1002/phar.2026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric opioid and benzodiazepine withdrawal are avoidable complications of pain and sedation management that is well described in the literature. To prevent withdrawal from occurring, practitioners regularly use a steady decrease of pain and sedation medications, also known as a weaning or tapering schedule. The weaning schedule is highly variable based on clinician preference and is usually dependent on the clinician. The purposes of this review are to evaluate the current literature on the process of opioid and benzodiazepine weaning in pediatric patients and to assess the various standardized protocols used to decrease withdrawal occurrences. We conducted a search of the PubMed, MEDLINE, Cochrane Library, Cumulative Index of Nursing and Allied Health (CINAHL), Academic Search Premier, and PsycInfo databases. Studies were included if they described a wean or taper in pediatric patients aged 18 years or younger. Studies describing neonatal abstinence syndrome were excluded from the review. A total of 97 studies published between 2000 and 2014 were retrieved; of those, 15 studies met the inclusion criteria. Studies were evaluated for selection of withdrawal assessment tool, wean protocol summary, preferred weaning agents, benzodiazepine withdrawal, and wean-at-home regimen. The most common opioid-weaning protocol approaches described a 10-20% dose decrease per day. Benzodiazepine weaning was not regularly standardized or described. The use of a standardized opioid-weaning protocol reduced withdrawal rates compared with nonstandardized weaning plans. Benzodiazepine weaning was inconsistently evaluated and may have affected study outcomes. Identified areas of improvement include the use of newer withdrawal assessment tools validated in the older pediatric population and standardized withdrawal assessment and reporting.
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Affiliation(s)
- Norman E Fenn
- Purdue University College of Pharmacy, West Lafayette, Indiana
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200
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Treating Neonatal Abstinence Syndrome from Clinical Perspectives. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.6266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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