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Myers AM, Wallin CM, Richardson LM, Duran J, Neole SR, Kulaglic N, Davidson C, Perrine SA, Bowen SE, Brummelte S. The effects of buprenorphine and morphine during pregnancy: Impact of exposure length on maternal brain, behavior, and offspring neurodevelopment. Neuropharmacology 2024; 257:110060. [PMID: 38960134 PMCID: PMC11285462 DOI: 10.1016/j.neuropharm.2024.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/21/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
The escalating incidence of opioid-related issues among pregnant women in the United States underscores the critical necessity to understand the effects of opioid use and Medication for Opioid Use Disorders (MOUDs) during pregnancy. This research employed a translational rodent model to examine the impact of gestational exposure to buprenorphine (BUP) or morphine on maternal behaviors and offspring well-being. Female rats received BUP or morphine before conception, representing established use, with exposure continuing until postnatal day 2 or discontinued on gestational day 19 to mimic treatment cessation before birth. Maternal behaviors - including care, pup retrieval, and preference - as well as hunting behaviors and brain neurotransmitter levels were assessed. Offspring were evaluated for mortality, weight, length, milk bands, surface righting latency, withdrawal symptoms, and brain neurotransmitter levels. Our results reveal that regardless of exposure length (i.e., continued or discontinued), BUP resulted in reduced maternal care in contrast to morphine-exposed and control dams. Opioid exposure altered brain monoamine levels in the dams and offspring, and was associated with increased neonatal mortality, reduced offspring weight, and elevated withdrawal symptoms compared to controls. These findings underscore BUP's potential disruption of maternal care, contributing to increased pup mortality and altered neurodevelopmental outcomes in the offspring. This study calls for more comprehensive research into prenatal BUP exposure effects on the maternal brain and infant development with the aim to mitigate adverse outcomes in humans exposed to opioids during pregnancy.
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Affiliation(s)
- Abigail M Myers
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA
| | - Chela M Wallin
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA
| | | | - Jecenia Duran
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA
| | - Surbhi R Neole
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA
| | - Nejra Kulaglic
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA
| | - Cameron Davidson
- Dept of Behavioral Neuroscience and Psychiatry, Wayne State University, Detroit, MI, 48202, USA
| | - Shane A Perrine
- Dept of Behavioral Neuroscience and Psychiatry, Wayne State University, Detroit, MI, 48202, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI, 48202, USA
| | - Scott E Bowen
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, 48202, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI, 48202, USA.
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Chyi LJ, Li S, Lee C, Walsh EM, Kuzniewicz MW. Independent Impact of Eat, Sleep, Console Assessment on Neonatal Opioid Withdrawal Syndrome. Clin Pediatr (Phila) 2024; 63:1097-1105. [PMID: 37798943 DOI: 10.1177/00099228231204448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Compared with the Finnegan Neonatal Abstinence Scoring System (FNASS), the Eat, Sleep, Console (ESC) approach reduces pharmacotherapy and length of stay (LOS) for neonatal opioid withdrawal syndrome (NOWS) infants. The independent outcome contribution of ESC is unknown as the approach combines ESC assessment with additional management changes. Our objective was to evaluate ESC assessment's independent impact on outcomes compared with FNASS. We conducted a retrospective cohort study of in utero opioid-exposed infants ≥35 weeks gestation managed with FNASS versus ESC. Outcomes included pharmacotherapy initiation, LOS, length of pharmacotherapy, and emergency department visit/readmissions. Among 151 FNASS and 100 ESC managed infants, pharmacotherapy initiation (P = .47), LOS for all infants (P = .49), and LOS for pharmacologically treated infants (P = .68) were similar. Length of pharmacotherapy did not differ (P = .84). Emergency department evaluation/NOWS readmission was equally rare (P = .65). Using equivalent models of care, comparison of ESC and FNASS assessment tools showed no difference in NOWS outcomes.
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Affiliation(s)
- Lisa J Chyi
- Division of Neonatology, Department of Pediatrics, Kaiser Permanente, Walnut Creek, CA, USA
| | - Sherian Li
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Division of Neonatology, Department of Pediatrics, Kaiser Permanente, Santa Clara, CA, USA
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Tasket AL, Black MR, Brewer TL, Young ML. Educating Nurses to Improve Awareness and Use of a Human Milk Feeding Care Pathway for Opioid-Exposed Neonates. Nurs Womens Health 2024:S1751-4851(24)00162-4. [PMID: 39153739 DOI: 10.1016/j.nwh.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To increase nurses' awareness and use of a human milk feeding (HMF) and opioid use disorder (OUD) standardized care pathway to improve rates of HMF at discharge in opioid-exposed neonates (OENs). DESIGN Quality improvement project. SETTING/LOCAL PROBLEM Underutilizing an HMF and OUD standardized care pathway in an academic medical center led to declining HMF rates at discharge. PARTICIPANTS Staff nurses in the women and infants department (N = 311). INTERVENTION/MEASUREMENTS Nurses completed an asynchronous online educational module regarding awareness and use of the HMF and OUD standardized care pathway for supporting HMF in OENs. Monthly infographics were placed in each nursing unit to reinforce content. Nurses completed pre- and posteducation surveys to evaluate their knowledge and use of the pathway. After the education, rates of OENs receiving human milk at discharge were collected from the electronic health record. RESULTS A total of 240 (77.2%) nurses participated in the educational module; awareness of the pathway increased from 91.5% to 97.3%. HMF rate at discharge significantly increased from 29.8% to 59.4% (p = .03). CONCLUSION Improved awareness among nurses of a standardized HMF and OUD care pathway was associated with a doubling of HMF rates at discharge in OENs.
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Straub L, Bateman BT, Hernández-Díaz S, Zhu Y, Suarez EA, Vine SM, Jones HE, Connery HS, Davis JM, Gray KJ, Lester B, Terplan M, Zakoul H, Mogun H, Huybrechts KF. Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone. JAMA 2024:2822178. [PMID: 39133511 PMCID: PMC11320336 DOI: 10.1001/jama.2024.11501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 08/13/2024]
Abstract
Importance Buprenorphine combined with naloxone is commonly used to treat opioid use disorders outside of pregnancy. In pregnancy, buprenorphine alone is generally recommended because of limited perinatal safety data on the combination product. Objective To compare perinatal outcomes following prenatal exposure to buprenorphine with naloxone vs buprenorphine alone. Design, Settings, and Participants Population-based cohort study using health care utilization data from Medicaid-insured beneficiaries in the US from 2000 to 2018. The cohort was restricted to pregnant individuals linked to their liveborn infants, with maternal Medicaid enrollment from 3 months before pregnancy to 1 month after delivery and infant enrollment for the first 3 months after birth, unless they died sooner. Exposure Use of buprenorphine with naloxone vs buprenorphine alone during the first trimester based on outpatient dispensings. Main Outcomes and Measures Outcomes included major congenital malformations, low birth weight, neonatal abstinence syndrome, neonatal intensive care unit admission, preterm birth, respiratory symptoms, small for gestational age, cesarean delivery, and maternal morbidity. Confounder-adjusted risk ratios were calculated using propensity score overlap weights. Results This study identified 3369 pregnant individuals exposed to buprenorphine with naloxone during the first trimester (mean [SD] age, 28.8 [4.6] years) and 5326 exposed to buprenorphine alone or who switched from the combination to buprenorphine alone by the end of the first trimester (mean [SD] age, 28.3 [4.5] years). When comparing buprenorphine combined with naloxone with buprenorphine alone, a lower risk for neonatal abstinence syndrome (absolute risk, 37.4% vs 55.8%; weighted relative risk, 0.77 [95% CI, 0.70-0.84]) and a modestly lower risk for neonatal intensive care unit admission (absolute risk, 30.6% vs 34.9%; weighted relative risk, 0.91 [95% CI, 0.85-0.98]) and small for gestational age (absolute risk, 10.0% vs 12.4%; weighted relative risk, 0.86 [95% CI, 0.75-0.98]) was observed. For maternal morbidity, the comparative rates were 2.6% vs 2.9%, respectively, and the weighted relative risk was 0.90 (95% CI, 0.68-1.19). No differences were observed with respect to major congenital malformations overall, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery. Results were consistent across sensitivity analyses. Conclusions and Relevance There were similar and, in some instances, more favorable neonatal and maternal outcomes for pregnancies exposed to buprenorphine combined with naloxone compared with buprenorphine alone. For the outcomes assessed, compared with buprenorphine alone, buprenorphine with naloxone during pregnancy appears to be a safe treatment option. This supports the view that both formulations are reasonable options for the treatment of opioid use disorder in pregnancy, affirming flexibility in collaborative treatment decision-making.
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Affiliation(s)
- Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Suarez
- Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Seanna M. Vine
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hendrée E. Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Hilary S. Connery
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jonathan M. Davis
- Department of Pediatrics, Tufts Medical Center and Tufts Clinical and Translational Science Institute, Boston, Massachusetts
| | - Kathryn J. Gray
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Barry Lester
- Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Women & Infants Hospital, Providence, Rhode Island
| | | | - Heidi Zakoul
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Singh R, Melvin P, Wachman EM, Rothstein R, Schiff DM, Murzycki J, VanVleet M, Gupta M, Davis JM. Short term outcomes of neonatal opioid withdrawal syndrome: a comparison of two approaches. J Perinatol 2024; 44:1137-1145. [PMID: 38565652 DOI: 10.1038/s41372-024-01953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To evaluate outcomes in opioid exposed neonates (OENs) assessed by the Eat, Sleep, Console (ESC) tool compared to the Finnegan Neonatal Abstinence Scoring System (FNASS). METHODS Retrospective analysis of a statewide database of OENs from 2017 to 2020 with birthing hospitals classified based on the assessment tool used. Four main outcomes were examined using multivariable and Poisson logistic regression models. RESULTS Of 2375 OENs, 42.1% received pharmacotherapy (PT) with a consistent decrease in PT, length of treatment (LOT), and length of stay (LOS) over the study period. There was no change in use of mother's own milk (MoM). While outcomes were significantly associated with several specific variables, there were no differences in outcomes between assessment methods. CONCLUSION While there was a significant decrease over time in PT, LOT, and LOS, improvements were independent of the assessment tool used and likely related to the increased use of non-pharmacologic care.
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Affiliation(s)
- Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.
| | - Patrice Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Robert Rothstein
- Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA
| | - Davida M Schiff
- Divisions of Newborn Medicine and General Academic Pediatrics, Massachusetts General for Children, Boston, MA, USA
| | - Jennifer Murzycki
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
| | - Marcia VanVleet
- Division of Newborn Medicine, Baystate Franklin Medical Center, Greenfield, MA, USA
| | - Munish Gupta
- Division of Newborn Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan M Davis
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
- The Tufts Clinical and Translational Science Institute, Boston, MA, USA
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Calihan JB, Matson P. Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care. Curr Opin Pediatr 2024; 36:358-366. [PMID: 38655792 DOI: 10.1097/mop.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use. RECENT FINDINGS There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use. SUMMARY Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Pamela Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ward MK, Guille C, Jafry A, Gwanzura T, Pryce K, Lewis P, Brady KT. Digital health interventions to support women with opioid use disorder: A scoping review. Drug Alcohol Depend 2024; 261:111352. [PMID: 38861765 DOI: 10.1016/j.drugalcdep.2024.111352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Digital health interventions have the potential to address barriers to care for women. To design effective digital health interventions that meet the needs of this population, a full assessment of the existing literature is required. METHODS This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. A total of four databases were searched: Medline (OVID), Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsychInfo. Search terms were informed by a preliminary search and included synonyms for opioid use disorder, digital health, and women. Abstract screening and full text review was completed after reviewer calibration. Data extraction was carried out through data charting. RESULTS After removal of duplicates, 901 abstracts were screened; the full text of 26 manuscripts were reviewed. After full text review, 17 studies published between 2018 and 2023 were included in the scoping review. Types of digital health interventions and study designs varied widely, with a majority focused on the peripartum period (n=12). Of 11 studies focused on OUD treatment, only three reported outcomes related to MOUD utilization. Two studies described community engagement to inform the development or modification of interventions. CONCLUSION A variety of digital health interventions are currently being used to address OUD among women. Areas for future work include examining efficacy for MOUD utilization, incorporating community engagement into intervention development, providing support for OUD treatment and recovery in the late postpartum period and beyond, and the development of mobile health applications.
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Affiliation(s)
- Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA.
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, USA
| | - Ayesha Jafry
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA
| | - Kayla Pryce
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-405, Miami, FL 33199, USA
| | - Patrice Lewis
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5-490, Miami, FL 33199, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, USA
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Rebbe R, Sieger ML, Reddy J, Prindle J. U.S. State rates of newborns reported to child protection at birth for prenatal substance exposure. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104527. [PMID: 39059078 DOI: 10.1016/j.drugpo.2024.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND In the U.S., the opioid epidemic has revitalized national attention to newborns with prenatal substance exposure (PSE). These newborns and their caregivers have specific health and treatment needs and frequently interact with multiple systems, including child protection systems (CPS). METHODS This study calculated rates of newborns (less than 15 days old) reported to CPS per 1,000 births due to PSE by state and year using data from the National Child Abuse and Neglect Data System (NCANDS). Given the lack of a clear definition of PSE reports in the data, we calculated rates using three different definitions. To examine the relationship between different state laws regarding the mandated reporting of PSE and PSE reports rates, we used panel data analysis. RESULTS Rates of newborn reports more than doubled between 2011 and 2019. There was extensive state variability of rates including some states that were consistently more than 100 % greater than and others consistently more than 150 % less than the annual national mean. Reporting rates were not associated with state requirements to report PSE, but were positively associated with rates of diagnosed neonatal abstinence syndrome. CONCLUSION State-level inconsistencies in identification, reporting, and CPS responses prevent a clear understanding of the scope of the affected population and service needs.
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Affiliation(s)
- Rebecca Rebbe
- University of North Carolina at Chapel Hill School of Social Work, 325 Pittsboro St, Chapel Hill, NC 27599, USA.
| | - Margaret Lloyd Sieger
- University of Kansas School of Medicine, Department of Population Health, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Julia Reddy
- University of North Carolina at Chapel Hill School of Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - John Prindle
- University of Southern California School of Social Work, 669W 34th St, Los Angeles, CA 90089, USA
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Dudley J, Gabrielson SMB, O'Connor AB, Ahrens KA. Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022. J Perinatol 2024; 44:1104-1110. [PMID: 38267636 DOI: 10.1038/s41372-024-01882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available. STUDY DESIGN We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees. RESULT From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values <0.01). Decreasing trends were also found among Medicaid enrollees. CONCLUSION In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization.
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Affiliation(s)
- Julia Dudley
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
| | - Sarah M B Gabrielson
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA
| | - Alane B O'Connor
- Perinatal Addiction Medicine, Maine Medical Center, Portland, ME, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
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10
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Tivnan P, Setty BN, Howard E, Agarwal J, Farris CW, Wachman EM, Castro-Aragon I. Ultrasound evaluation of brain parenchyma in preterm infants with prenatal opioid exposure. J Perinatol 2024; 44:1119-1124. [PMID: 37863985 DOI: 10.1038/s41372-023-01804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To evaluate whether preterm infants with prenatal opioid exposure had differences in brain size on head ultrasounds (HUS) in comparison to non-exposed infants. STUDY DESIGN Preterm infants ≤34 weeks with prenatal opioid exposure (n = 47) and matched non-exposed infants (n = 62) with early HUSs were examined. Fifteen brain measurements were made and linear regression models performed to evaluate differences. RESULTS Brain measurements were smaller in the right ventricular index [β = -0.18 mm (95% CI -0.32, -0.03]), left ventricular index [β = -0.04 mm (95% CI -0.08, -0.003)], left basal ganglia insula [β = -0.10 mm (95% CI -0.15, -0.04)], right basal ganglia insula [β = -0.08 mm (95% CI -0.14, -0.03)], corpus callosum fastigium length [β = -0.16 mm (95% CI -0.25, -0.06)], intracranial height index [β = -0.31 mm (95% CI -0.44, -0.18)], and transcerebellar measurements [β = -0.13 (95% CI -0.25, -0.02)] in the opioid-exposed group. CONCLUSIONS Preterm infants with prenatal opioid exposure have smaller brain sizes compared to non-exposed infants, potentially increasing their risk for neurodevelopmental abnormalities.
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Affiliation(s)
- Patrick Tivnan
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Radiology, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Bindu N Setty
- Department of Pediatric Radiology, Boston University Chobanian & Avedisian School of Medicine, 715 Albany Street, Boston, MA, 02118, USA
| | - Eileen Howard
- Boston University Chobanian & Avedisian School of Medicine, 715 Albany Street, Boston, MA, 02118, USA
| | - Joel Agarwal
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Chad W Farris
- Department of Pediatric Radiology, Boston University Chobanian & Avedisian School of Medicine, 715 Albany Street, Boston, MA, 02118, USA
| | - Elisha M Wachman
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, 715 Albany Street, Boston, MA, 02118, USA
| | - Ilse Castro-Aragon
- Department of Pediatric Radiology, Boston University Chobanian & Avedisian School of Medicine, 715 Albany Street, Boston, MA, 02118, USA
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11
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Alsmadi MM. Salivary Therapeutic Monitoring of Buprenorphine in Neonates After Maternal Sublingual Dosing Guided by Physiologically Based Pharmacokinetic Modeling. Ther Drug Monit 2024; 46:512-521. [PMID: 38366333 DOI: 10.1097/ftd.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/08/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) during pregnancy is associated with high mortality rates and neonatal opioid withdrawal syndrome (NOWS). Buprenorphine, an opioid, is used to treat OUD and NOWS. Buprenorphine active metabolite (norbuprenorphine) can cross the placenta and cause neonatal respiratory depression (EC 50 = 35 ng/mL) at high brain extracellular fluid (bECF) levels. Neonatal therapeutic drug monitoring using saliva decreases the likelihood of distress and infections associated with frequent blood sampling. METHODS An adult physiologically based pharmacokinetic model for buprenorphine and norbuprenorphine after intravenous and sublingual administration was constructed, vetted, and scaled to newborn and pregnant populations. The pregnancy model predicted that buprenorphine and norbuprenorphine doses would be transplacentally transferred to the newborns. The newborn physiologically based pharmacokinetic model was used to estimate the buprenorphine and norbuprenorphine levels in newborn plasma, bECF, and saliva after these doses. RESULTS After maternal sublingual administration of buprenorphine (4 mg/d), the estimated plasma concentrations of buprenorphine and norbuprenorphine in newborns exceeded the toxicity thresholds for 8 and 24 hours, respectively. However, the norbuprenorphine bECF levels were lower than the respiratory depression threshold. Furthermore, the salivary buprenorphine threshold levels in newborns for buprenorphine analgesia, norbuprenorphine analgesia, and norbuprenorphine hypoventilation were observed to be 22, 2, and 162 ng/mL. CONCLUSIONS Using neonatal saliva for buprenorphine therapeutic drug monitoring can facilitate newborn safety during the maternal treatment of OUD using sublingual buprenorphine. Nevertheless, the suitability of using adult values of respiratory depression EC 50 for newborns must be confirmed.
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Affiliation(s)
- Mo'tasem M Alsmadi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; and
- Nanotechnology Institute, Jordan University of Science and Technology, Irbid, Jordan
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Jones CM, Zhang K, Han B, Guy GP, Losby J, Einstein EB, Delphin-Rittmon M, Volkow ND, Compton WM. Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021. JAMA Psychiatry 2024; 81:789-796. [PMID: 38717781 PMCID: PMC11079787 DOI: 10.1001/jamapsychiatry.2024.0810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 05/12/2024]
Abstract
Importance Parents' overdose death can have a profound short- and long-term impact on their children, yet little is known about the number of children who have lost a parent to drug overdose in the US. Objective To estimate the number and rate of children who have lost a parent to drug overdose from 2011 to 2021 overall and by parental age, sex, and race and ethnicity. Design, Setting, and Participants This was a cross-sectional study of US community-dwelling persons using data from the National Survey on Drug Use and Health (2010-2014 and 2015-2019) and the National Vital Statistics System (2011-2021). Data were analyzed from January to June 2023. Exposure Parental drug overdose death, stratified by age group, sex, and race and ethnicity. Main Outcomes and Measures Numbers, rates, and average annual percentage change (AAPC) in rates of children losing a parent aged 18 to 64 years to drug overdose, overall and by age, sex, and race and ethnicity. Results From 2011 to 2021, 649 599 adults aged 18 to 64 years died from a drug overdose (mean [SD] age, 41.7 [12.0] years; 430 050 [66.2%] male and 219 549 [33.8%] female; 62 606 [9.6%] Hispanic, 6899 [1.1%] non-Hispanic American Indian or Alaska Native, 6133 [0.9%] non-Hispanic Asian or Pacific Islander, 82 313 [12.7%] non-Hispanic Black, 485 623 [74.8%] non-Hispanic White, and 6025 [0.9%] non-Hispanic with more than 1 race). Among these decedents, from 2011 to 2021, an estimated 321 566 (95% CI, 276 592-366 662) community-dwelling children lost a parent aged 18 to 64 years to drug overdose. The rate of community-dwelling children who lost a parent to drug overdose per 100 000 children increased from 27.0 per 100 000 in 2011 to 63.1 per 100 000 in 2021. The highest rates were found among children of non-Hispanic American Indian or Alaska Native individuals, who had a rate of 187.1 per 100 000 in 2021, more than double the rate among children of non-Hispanic White individuals (76.5 per 100 000) and non-Hispanic Black individuals (73.2 per 100 000). While rates increased consistently each year for all parental age, sex, and race and ethnicity groups, non-Hispanic Black parents aged 18 to 25 years had the largest AAPC (23.8%; 95% CI, 16.5-31.6). Rates increased for both fathers and mothers; however, more children overall lost fathers (estimated 192 459; 95% CI, 164 081-220 838) than mothers (estimated 129 107; 95% CI, 112 510-145 824). Conclusions and Relevance An estimated 321 566 children lost a parent to drug overdose in the US from 2011 to 2021, with significant disparities evident across racial and ethnic groups. Given the potential short- and long-term negative impact of parental loss, program and policy planning should ensure that responses to the overdose crisis account for the full burden of drug overdose on families and children, including addressing the economic, social, educational, and health care needs of children who have lost parents to overdose.
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Affiliation(s)
| | - Kun Zhang
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Gery P. Guy
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Losby
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily B. Einstein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Ganetsky VS, Yates B, Salzman M, Heil J, Jones I, Hunter K, Perry RL, Baston KE. A Retrospective Cohort Study of Disparities in Urine Drug Testing During the Perinatal Period in an Urban, Academic Medical Center. Matern Child Health J 2024; 28:1395-1403. [PMID: 38847989 PMCID: PMC11269382 DOI: 10.1007/s10995-024-03940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/25/2024]
Abstract
The purpose of this study was to evaluate disparities in urine drug testing (UDT) during perinatal care at a single academic medical center. This retrospective cohort study included patients who had a live birth and received prenatal care at our institution between 10/1/2015 and 9/30/2020. The primary outcomes were maternal UDT during pregnancy (UDTPN) and UDT only at delivery (UDTDEL). Secondary outcomes included the number of UDTs (UDTNUM) and the association between a positive UDT test result and race/ethnicity. Mixed model logistic regression and negative binomial regression with clustering based on prenatal care locations were used to control for confounders. Of 6,240 live births, 2,265 (36.3%) and 167 (2.7%) received UDTPN and UDTDEL, respectively. Black (OR 2.09, 95% CI 1.54-2.84) and individuals of Other races (OR 1.64, 95% CI 1.03-2.64) had greater odds of UDTPN compared to non-Hispanic White individuals. Black (beta = 1.12, p < 0.001) and Hispanic individuals (beta = 0.78, p < 0.001) also had a positive relationship with UDTNUM. Compared to individuals with non-Medicaid insurance, those insured by Medicaid had greater odds of UDTPN (OR 1.66, 95% CI 1.11-2.49) and had a positive relationship with UDTNUM (beta = 0.89, p < 0.001). No significant associations were found for UDTDEL and race/ethnicity. Despite receiving more UDT, Black individuals were not more likely to have a positive test result compared to non-Hispanic White individuals (OR 0.95, 95% CI 0.72-1.25). Our findings demonstrate persistent disparities in substance use testing during the perinatal period.
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Affiliation(s)
- Valerie S Ganetsky
- Center for Healing, Division of Addiction Medicine, Cooper University Health Care, Camden, NJ, USA.
| | - Brianna Yates
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Salzman
- Center for Healing, Division of Addiction Medicine, Cooper University Health Care, Camden, NJ, USA
- Department of Emergency Medicine, Division of Addiction Medicine and Medical Toxicology, Cooper University Health Care, Camden, NJ, USA
| | - Jessica Heil
- Center for Healing, Division of Addiction Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Iris Jones
- Center for Healing, Division of Addiction Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Krystal Hunter
- Cooper University Health Care, Cooper Research Institute, Camden, NJ, USA
| | - Robin L Perry
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA
| | - Kaitlan E Baston
- Center for Healing, Division of Addiction Medicine, Cooper University Health Care, Camden, NJ, USA
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Schiff DM, Li WZM, Work EC, Goullaud L, Vazquez J, Paulet T, Dorfman S, Selk S, Hoeppner BB, Wilens T, Bernstein JA, Diop H. Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209346. [PMID: 38789329 DOI: 10.1016/j.josat.2024.209346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Racial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. METHODS Peer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. RESULTS The study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. CONCLUSION Pregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America; Division of Newborn Medicine, MassGeneral for Children, Boston, MA, 02114, United States of America.
| | - William Z M Li
- Harvard Medical School, Boston, MA, United States of America
| | - Erin C Work
- University of California, Schools of Public Health and Social Welfare, Los Angeles, CA, United States of America
| | - Latisha Goullaud
- Institute for Health and Recovery, Watertown, MA, United States of America
| | | | - Tabhata Paulet
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Sarah Dorfman
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America
| | - Sabrina Selk
- National Network of Public Health Initiatives, Washington, DC, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Timothy Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Judith A Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA, 02108, United States of America
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Kristensen AW, Vestermark V, Kjærbye‐Thygesen A, Eckhardt M, Kesmodel US. Maternal opioid use during pregnancy and the risk of neonatal opioid withdrawal syndrome in the offspring. Acta Obstet Gynecol Scand 2024; 103:1522-1529. [PMID: 38700023 PMCID: PMC11266641 DOI: 10.1111/aogs.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Neonatal opioid withdrawal syndrome (NOWS) is caused by sudden cessation from in utero exposure to opioids. The indications for opioid use during pregnancy are diverse including medication for opioid use disorder and analgesia. The opioid dose typically depends on the indication, with higher doses used for medication for opioid use disorder and lower doses used for analgesia. The aim of this study was to investigate the relationship between maternal opioid dose during pregnancy and the risk of NOWS. MATERIAL AND METHODS We conducted a historical multicenter cohort study of neonates prenatally exposed to opioids in Eastern Denmark during a six-year period from 2013 to 2018. The data was extracted from reviewing the individual's medical record(s), which were identified through a search of the Danish National Patient Register. Four groups (quartiles) according to maternal opioid dose during the last four weeks prior to delivery were compared. Unadjusted and adjusted logistic regression analyses were conducted to examine the risk of NOWS while controlling for relevant covariates. RESULTS A total of 130 in utero opioid exposed neonates were included. The majority of the pregnant patients (88%) were treated with opioids for analgesic purposes. Overall, 52% of neonates developed NOWS. The cumulative incidence of NOWS was 21%, 28%, 67% and 91% at maternal average daily dose of morphine milligram equivalent during the last four weeks prior to delivery of 0.7-14 (group I), 14.3-38.6 (group II), 40-90 (group III) and 90.9-1440 (group IV), respectively. Compared to group I the adjusted odds (aOR) of NOWS increased significantly in group III (aOR 10.6 [2.9-39.1]) and group IV (aOR 37.8 [7.6-188.2]) but not in group II (aOR 1.5 [0.4-5.2]). No cases of NOWS were reported at maternal dose less than an average daily dose of five morphine milligram equivalent during the last four weeks prior to delivery. No significant changes in the incidence of NOWS were observed between 2013 and 2018. CONCLUSIONS The odds of neonatal opioid withdrawal syndrome increased significantly as the maternal average daily dose of morphine milligram equivalent during the last four weeks prior to delivery surpassed 40.
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Affiliation(s)
- Anna Warncke Kristensen
- Department of Obstetrics and GynecologyNaestved, Slagelse, Ringsted HospitalsSlagelseDenmark
| | - Vibeke Vestermark
- Department of Obstetrics and GynecologyNaestved, Slagelse, Ringsted HospitalsSlagelseDenmark
| | | | | | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and GynecologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Ehrenthal DB, Wang Y, Pac J, Durrance CP, Kirby RS, Berger LM. Trends in prenatal prescription opioid use among Medicaid beneficiaries in Wisconsin, 2010-2019. J Perinatol 2024; 44:1111-1118. [PMID: 38561393 DOI: 10.1038/s41372-024-01954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine changes in prenatal opioid prescription exposure following new guidelines and policies. STUDY DESIGN Cohort study of all (262,284) Wisconsin Medicaid-insured live births 2010-2019. Prenatal exposures were classified as analgesic, short term, and chronic (90+ days), and medications used to treat opioid use disorder (MOUD). We describe overall and stratified temporal trends and used linear probability models with interaction terms to test their significance. RESULT We found 42,437 (16.2%) infants with prenatal exposure; most (90.5%) reflected analgesic opioids. From 2010 to 2019, overall exposure declined 12.8 percentage points (95% CI = 12.1-13.1). Reductions were observed across maternal demographic groups and in both rural and urban settings, though the extent varied. There was a small reduction in chronic analgesic exposure and a concurrent increase in MOUD. CONCLUSION Broad and sustained declines in prenatal prescription opioid exposure occurred over the decade, with little change in the percentage of infants chronically exposed.
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Affiliation(s)
- Deborah B Ehrenthal
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA.
| | - Yi Wang
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
- Silberman School of Social Work, Hunter College, City University of New York, New York, NY, USA
| | - Jessica Pac
- Sandra Rosenbaum School of Social Work, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Christine Piette Durrance
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lawrence M Berger
- Sandra Rosenbaum School of Social Work, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Jones J, Coy D, Gidron D, Hariharan S, Jones M, Patel N, Racines A, Toma S, Brown G. Using umbilical cord tissue to identify prenatal ethanol exposure and co-exposure to other commonly misused substances. J Perinatol 2024:10.1038/s41372-024-02075-2. [PMID: 39069544 DOI: 10.1038/s41372-024-02075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Substance misuse during pregnancy can result in a variety of poor pregnancy outcomes. Objective data reporting the prevalence of neonates born with ethanol metabolites (evidence of prenatal ethanol exposure) in their fluids or tissues are limited. STUDY DESIGN A secondary analysis of umbilical cord tissue specimens received for routine toxicological analysis was conducted. Prevalences of ethyl glucuronide (EtG), a long-term direct ethanol biomarker, were determined using a new laboratory tool, LDTD-MSMS. Additionally, other commonly misused substances were determined using routine procedures. RESULTS Of 12,995 specimens, 238 (1.8%) specimens contained EtG. Concentrations of EtG ranged from 5 ng/g to 6679 ng/g (median 47 ng/mg; IQR: 16 ng/g, 203 ng/g). Of those 238 EtG-positive specimens, nearly 58% (N = 138) contained additional substances or metabolites. CONCLUSION Self-report of substance use during pregnancy is under-reported. We have demonstrated co-exposure of substances with ethanol is higher than previous reports.
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Affiliation(s)
- Joseph Jones
- United States Drug Testing Laboratories, Des Plaines, IL, USA.
| | - Donna Coy
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | | | | | - Mary Jones
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | - Niranjan Patel
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | - Amy Racines
- United States Drug Testing Laboratories, Des Plaines, IL, USA
| | - Sarah Toma
- United States Drug Testing Laboratories, Des Plaines, IL, USA
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18
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Renbarger KM. Factors Influencing Maternal Substance Use and Recovery in the Perinatal Period. West J Nurs Res 2024:1939459241266736. [PMID: 39058287 DOI: 10.1177/01939459241266736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Substance use disorders (SUD) in the perinatal period have risen dramatically over the past 2 decades. Substance use disorders can have deleterious effects on maternal-infant health. Recovery can improve quality of life but can be challenging for women with SUD in the perinatal period. It is important for health care providers to have an understanding of factors associated with maternal substance use and recovery. OBJECTIVE The purpose of this qualitative review was to identify factors influencing substance use and recovery in women with SUD in the perinatal period. METHODS A systematic search was conducted using the databases of CINAHL, PsycINFO, and PubMed along with a manual search of Google Scholar. The studies were assessed using criteria from the Joanna Briggs Institute's critical appraisal checklist for qualitative research. RESULTS Findings from 16 qualitative studies were synthesized. Six descriptive subthemes identifying factors influencing substance use and recovery were revealed: (1) Infant Care, (2) Stigma, (3) Social Settings Involving Substance Use, (4) Internalized Stigma and Mental Health Symptoms, (5) Addiction Concerns, and (6) Coping Abilities. CONCLUSIONS Participants described external and internal factors that influenced their substance use and recovery. The findings suggest health care providers refer women to residential addiction treatment, use destigmatizing language, promote access to peer services, and provide trauma-informed care.
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Anbalagan S, Anderson V, Favara MT, Stark D, Carola D, Solarin K, Adeniyi-Jones S, Kraft WK, Aghai ZH. Buprenorphine vs. morphine: impact on neonatal opioid withdrawal syndrome (NOWS) outcomes in a single center retrospective study. J Perinatol 2024:10.1038/s41372-024-02046-7. [PMID: 39003405 DOI: 10.1038/s41372-024-02046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES To compare clinical outcomes for infants with neonatal opioid withdrawal syndrome (NOWS) treated with buprenorphine or morphine. STUDY DESIGN Retrospective study of infants born ≥35 weeks' gestation and admitted to the NICU for NOWS treatment between 2011 and 2022. Length of treatment, length of stay in the hospital, and the need for secondary medications were compared between buprenorphine and morphine treated neonates. Multiple regression analysis was performed, adjusting for baseline differences and confounders. RESULTS 417 neonates were treated with morphine and 232 with buprenorphine. The buprenorphine group had shorter treatment days [-10.8 days; 95% CI: -8.08 to -13.53] and shorter hospital stay [-11.8 days; 95% CI: -8.83 to -14.78]. The buprenorphine group was no more likely to receive phenobarbital or clonidine (26% vs. 29%). CONCLUSION In this large single-center study, buprenorphine was associated with shorter lengths of treatment and hospital stay in the treatment of NOWS compared to morphine.
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Affiliation(s)
- Saminathan Anbalagan
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA.
- Deparment of Pediatrics/Neonatology, University of South Alabama, Mobile, AL, USA.
| | - Victoria Anderson
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA
| | - Michael T Favara
- Deparment of Pediatrics/Neonatology, ChristianaCare Hospital, Newark, DE, USA
| | - Daniela Stark
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA
| | - David Carola
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA
| | - Kolawole Solarin
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA
| | - Susan Adeniyi-Jones
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA
| | - Walter K Kraft
- Department of Pharmacology, Physiology, and Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zubair H Aghai
- Deparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA
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Muhar A, McNeer E, Presley LD, Morad A, Loch SF, Dupont WD, Patrick SW. Use of Medications for Opioid Use Disorder and Child Welfare Outcomes. JAMA HEALTH FORUM 2024; 5:e241768. [PMID: 38995635 PMCID: PMC11245717 DOI: 10.1001/jamahealthforum.2024.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
This cohort study investigates whether use of medications for opioid use disorder in pregnancy is associated with higher rates of infants discharge home with their mothers after birth.
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Affiliation(s)
- Alexandra Muhar
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth McNeer
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren D Presley
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Morad
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah F Loch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William D Dupont
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen W Patrick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Now with Department of Health Policy and Management, Rollins School of Public Health, Atlanta, Georgia
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21
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Bagwell GA, Kenner C. Changing the Lens on How We View Mothers of Neonates with Intrauterine Substance Exposure. J Perinat Neonatal Nurs 2024; 38:232-233. [PMID: 39074316 DOI: 10.1097/jpn.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
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22
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Mantri S, Cheng AC, Saia K, Shrestha H, Amgott R, Bressler J, Werler MM, Carter G, Jones HE, Wachman EM. Neurobehavioral outcomes of infants exposed to buprenorphine-naloxone compared with naltrexone during pregnancy. Early Hum Dev 2024; 194:106051. [PMID: 38815498 DOI: 10.1016/j.earlhumdev.2024.106051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/26/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Naltrexone is a medication used to treat both opioid and alcohol use disorder with limited experience in pregnant individuals, particularly in comparison to more commonly utilized treatments such as buprenorphine-naloxone. The long-term outcomes of infants exposed to naltrexone has not been previously examined. AIMS To compare the neurobehavioral outcomes of naltrexone versus buprenorphine-naloxone exposed infants. STUDY DESIGN Multi-centered prospective cohort study. SUBJECTS Pregnant people on prescribed buprenorphine-naloxone or naltrexone were enrolled during pregnancy and the dyad followed until 12 months after delivery. OUTCOME MEASURES Infants were evaluated at 4-6 weeks corrected gestational age (CGA) using the NICU Neonatal Neurobehavioral Scale (NNNS) and at the 12-month CGA visit using the Ages and Stages Questionnaire, Third Edition (ASQ-3). RESULTS There were 7 dyads in the naltrexone group and 34 in the buprenorphine-naloxone group. On the NNNS, infants exposed to naltrexone had higher median scores for arousal and excitability, and lower median scores for attention and regulation at 4-6 weeks CGA compared to the buprenorphine-naloxone group. None of the infants in the naltrexone group were monitored for NOWS and had shorter length of hospital stay compared with the buprenorphine-naloxone group. Although no statistically significant differences were observed, more infants in the buprenorphine-naloxone group were identified as at risk for development delays in the communication, problem solving, and personal social domains of the ASQ-3 at 12 months CGA. Results should be interpreted with caution given this study's small sample size and lack of a prospective comparison cohort. CONCLUSIONS In this small cohort, there are differences noted in infant neurobehavior by NNNS at 4-6 weeks of age when comparing the buprenorphine-naloxone and naltrexone groups. At 12 months, ASQ-3 scores were similar but with percentage differences in potential development delay risk observed between the two groups. Larger cohort studies are needed to determine the long-term child outcomes after naltrexone exposure in pregnancy.
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Affiliation(s)
- Saaz Mantri
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA, United States of America.
| | - An-Chiao Cheng
- Department of Pediatrics, Boston Medical Center, 670 Albany Street, Boston, MA 02118, United States of America.
| | - Kelley Saia
- Department of Obstetrics & Gynecology, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America.
| | - Hira Shrestha
- Department of Neurology, McCance Center for Brain Health, Massachusetts General Hospital, 399 Revolution Drive, Somerville, MA 02145, United States of America.
| | - Rachel Amgott
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, United States of America.
| | - Jonathan Bressler
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, United States of America.
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States of America.
| | - Ginny Carter
- Department of Obstetrics & Gynecology, University of North Carolina, 410 N Greensboro St, Carrboro, NC 27510, United States of America.
| | - Hendree E Jones
- Department of Obstetrics & Gynecology, University of North Carolina, 410 N Greensboro St, Carrboro, NC 27510, United States of America.
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, United States of America.
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Jansson LM, McConnell K, Velez ML, Spencer N, Milio L, Leoutsakos J, DiPietro JA. Gestational buprenorphine-naloxone exposure and fetal neurobehavior. Neurotoxicol Teratol 2024; 104:107368. [PMID: 38906389 PMCID: PMC11300143 DOI: 10.1016/j.ntt.2024.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Buprenorphine-naloxone treatment may confer substantial benefits for the treatment of opioid use disorder (OUD) during pregnancy including lower risk for overdose/death, less diversion potential and reduced use of other substances. Treatment may also result in less severe Neonatal Abstinence Syndrome (NAS), but little is known about the effects of this medication on fetal neurodevelopment. METHODS The purpose of the current study is to evaluate neurobehaviors among fetuses exposed to buprenorphine-naloxone at four time points over the second and third trimesters of gestation in pregnant women with OUD on buprenorphine-naloxone therapy. Sixty minutes of continuous fetal monitoring via fetal actocardiograph with a single wide array abdominal transducer took place at times of peak and trough buprenorphine-naloxone levels in 24 pregnant women. Data collection, which included measures of fetal heart rate and motor activity, was conducted between 24 and 36 weeks gestation, with the majority (84.6%) monitored at two or more gestational ages. Medication dose and other substance use was monitored throughout the study and infant NAS severity was assessed. RESULTS Fetal heart rate (FHR), FHR variability, accelerations in FHR, and motor activity were suppressed when buprenorphine-naloxone levels were at pharmacologic peak as compared to trough concentrations at 36 weeks, but not earlier in gestation. Maternal medication dose was unrelated to infant NAS severity. CONCLUSIONS Conclusions: There were evident subclinical fetal neurophysiological responses at times of peak maternal buprenorphine/naloxone levels in later gestation, similar to those previously described for buprenorphine only. Further studies evaluating the effects of these changes in fetal neurobehaviors on the longer-term infant development are needed.
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Affiliation(s)
- Lauren M Jansson
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21224, USA.
| | - Krystle McConnell
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21224, USA
| | - Martha L Velez
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21224, USA
| | - Nancy Spencer
- Johns Hopkins Bayview Medical Center, Department of Nursing, Baltimore, MD 21224, USA
| | - Lorraine Milio
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD 21224, USA
| | - Jeannie Leoutsakos
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA
| | - Janet A DiPietro
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, MD 21224, USA
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Titus-Glover D, Shaya FT, Welsh C, Roane L. The Lived Experiences of Pregnant and Parenting Women in Recovery Toward Medication Treatment for Opioid Use Disorder. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:367-377. [PMID: 38254261 DOI: 10.1177/29767342231221055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Maternal misuse of prescription opioids and illicit drugs such as, heroin and non-pharmaceutical fentanyl analogs has increased in the last 2 decades and one in 5 women reported misuse of opioids. Medications for opioid use disorder (MOUD) are recommended for treating pregnant women with opioid use disorder (OUD). MOUD is effective in reducing cravings and negative outcomes, yet treatment is underutilized and varies in integration and intensity of resources across health systems. Exploring perceptions of MOUD delivery among pregnant/parenting women promises to uncover and address the underlying challenges to treatment, a perspective that may be different for providers and stakeholders. Therefore, our main purpose is to elicit patients' experiences and perceptions of MOUD, associated access to treatment, and availability of supportive resources during pregnancy/postpartum to inform OUD treatment. METHODS Through a qualitative research approach we gathered data from individual interviews/focus group discussions for this pilot study. Pregnant and postpartum parenting women (n = 17) responded to questions related to perceptions of MOUD, access to treatment, and availability of social and psychosocial resources. Data were collected, transcribed, and coded (by consensus) and emerging themes were analyzed using grounded theory methodology. RESULTS Emerging themes revealed positive uptake and perceptions of MOUD, continuing gaps in knowledge, negative impact of stigmatization, and limited access to programs and resources. Supportive relationships from family, peers, healthcare providers and child welfare staff, and co-located services were perceived as positive motivators to recovery. CONCLUSIONS Through the unique lenses of women with lived experience, this study revealed several themes that can be transformative for women. Overall perceptions of MOUD were positive and likely to facilitate uptake and promote positive recovery outcomes. Bridging knowledge gaps will reduce anxieties, fears about neonatal opioid withdrawal syndrome and adverse maternal outcomes. Additionally, a deeper understanding of stigmatization and relationships can inform an integrated patient-centered approach to OUD treatment.
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Affiliation(s)
| | - Fadia T Shaya
- Department of Practice, Sciences and Health Outcomes Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Christopher Welsh
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, USA
| | - Lynnee Roane
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Harrison JM, Stein BD, Loch SF, Lorch SA, Patrick SW. Hospital Quality Indicators for Opioid-Exposed Infants: Results From an Expert Consensus Panel. Pediatrics 2024; 154:e2024065721. [PMID: 38853654 PMCID: PMC11214929 DOI: 10.1542/peds.2024-065721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants. METHODS We used the ExpertLens online platform to conduct a 3-round modified Delphi panel. Expert panelists included health care providers, parents in recovery, quality experts, and public health experts. We identified 49 candidate quality indicators from a literature review and environmental scan. A total of 32 experts rated the importance and feasibility of the indicators using a 9-point Likert scale (Round 1), reviewed and discussed the initial ratings (round 2), and revised their original ratings (Round 3). Numeric scores corresponded with descriptive ratings of "low" (1-3), "uncertain" (4-6), or "high" (7-9). We measured consensus using the RAND/UCLA Appropriateness Method. RESULTS Candidate quality indicators assessed structures, processes, and outcomes in multiple domains of clinical care. After the final round, 36 indicators were rated "high" on importance and feasibility. Experts had strong consensus on the importance of quality indicators to assess universal screening of pregnant people for substance use disorder, hospital staff training, standardized assessment for neonatal opioid withdrawal syndrome, nonpharmacologic interventions, and transitions of care. For indicators focused on processes and outcomes, experts saw feasibility as dependent on the information routinely documented in electronic medical records or billing records. To present a more complete picture of hospital quality, experts suggested development of composite measures that summarize quality across multiple indicators. CONCLUSIONS A panel of experts reached consensus on a range of quality indicators for hospital-based care of opioid-exposed infants, with potential for use in national benchmarking, intervention studies, or hospital performance measurement.
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Affiliation(s)
| | - Bradley D. Stein
- RAND Corporation, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen W. Patrick
- RAND Corporation, Pittsburgh, Pennsylvania
- Vanderbilt Center for Child Health Policy
- Department of Pediatrics, Division of Neonatology
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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Jeminiwa R, Park S, Popielaski C, Gannon M, Myers R, Abatemarco DJ. Development of an Educational Brochure about Treatment Options for Pregnant Women with Opioid Use Disorders. PHARMACY 2024; 12:97. [PMID: 39051381 PMCID: PMC11270208 DOI: 10.3390/pharmacy12040097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
The goal of this study was to describe the development of an educational brochure for pregnant women with opioid use disorders (OUDs) about treatment options. Based on findings from a preliminary review of the literature, we drafted a brochure that addressed the following questions: (1) What are your options (Medication-Assisted Treatment (MAT) versus no treatment)? (2) What are the benefits of MAT? (3) What are the risks of MAT? (4) Can I take buprenorphine or methadone while breastfeeding? (5) Which medication should I choose? Clinicians and doulas (n = 19) who provide care to pregnant women with OUDs were recruited. Semi-structured interviews elicited participants' feedback on brochure content and their perceptions about brochure use for patient education. Thematic data analyses were performed. Three emergent themes were identified (suggested uses and settings of use, content revisions, and perceptions about the brochure) and used to refine the final brochure. This study provides valuable insights into the desired content of an educational brochure describing treatment options for pregnant women with OUDs from the provider's standpoint. Research is needed to assess the use of the brochure in shared decision-making conversations with providers about treatment.
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Affiliation(s)
- Ruth Jeminiwa
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA; (S.P.); (C.P.)
| | - Sohyeon Park
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA; (S.P.); (C.P.)
| | - Caroline Popielaski
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA; (S.P.); (C.P.)
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.G.); (D.J.A.)
| | - Ronald Myers
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Diane J. Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.G.); (D.J.A.)
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Halloum H, Daniels BJ, Beville D, Thrasher K, Martin GC, Ellsworth MA. Implementation of a Nurse-Driven Eat-Sleep-Console (ESC) Treatment Pathway at a Community Hospital for Treatment of Neonatal Opioid Withdrawal Syndrome in an Effort to Improve Short-term Outcomes. Adv Neonatal Care 2024; 24:212-218. [PMID: 38127593 DOI: 10.1097/anc.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND The Chandler Regional Medical Center (CRMC) neonatal intensive care unit (NICU) began a phased implementation of Eat-Sleep-Console (ESC) for the management of those at risk for neonatal opioid withdrawal syndrome (NOWS). PURPOSE The purpose of this initiative is to track short-term outcomes as well as the program's effect on nursing workflow and job performance rating/satisfaction. METHODS A retrospective review of the ESC implementation process at CRMC from the years 2018-2020. The study consisted of 3 epochs: (1) traditional pharmacologic management; (2) parent-led ESC management; and (3) parent/nurse-led ESC management. Length of stay (LOS), treatment pathway assignment, and proportion of infants treated with pharmacologic agents were compared between epochs. In addition, a survey of NICU nursing staff was distributed to measure nurses' perceptions and attitudes towards the ESC program and the management of infants with NOWS. RESULTS The proportion of infants treated via ESC increased (0%, 53%, and 100%), with an associated decrease in LOS (18.4, 10.5, and 9.3 days) during each epoch of the study period. Thirty-seven nurses completed the survey, with 94% of nurses reporting being comfortable caring for ESC patients and 89% feeling supported in their ESC nursing assignments, with only 11% stating that caring for ESC patients significantly alters their other nursing care processes. IMPLICATIONS FOR PRACTICE AND RESEARCH Implementation of an ESC treatment program for infants with NOWS significantly decreased LOS and the proportion of infants treated pharmacologically. This phased implementation process was not associated with self-reported negative nursing perceptions of the program and its treatment goals/outcomes.
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Affiliation(s)
- Hamza Halloum
- University of Arizona College of Medicine, Tucson (Mr Halloum); Chandler Regional Medical Center, Chandler, Arizona (Mss Daniels, Beville, and Thrasher); Phoenix Children's Hospital, Phoenix, Arizona (Drs Martin and Ellsworth); and University of Arizona College of Medicine-Phoenix (Drs Martin and Ellsworth)
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Taylor MG, Bauchat JR, Sorabella LL, Wanderer JP, Feng X, Shotwell MS, Ende HB. Neuraxial clonidine is not associated with lower post-cesarean opioid consumption or pain scores in parturients on chronic buprenorphine therapy: a retrospective cohort study. J Anesth 2024; 38:339-346. [PMID: 38461452 DOI: 10.1007/s00540-024-03314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 01/26/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Adequate post-cesarean delivery analgesia can be difficult to achieve for women diagnosed with opioid use disorder receiving buprenorphine. We sought to determine if neuraxial clonidine administration is associated with decreased opioid consumption and pain scores following cesarean delivery in women receiving chronic buprenorphine therapy. METHODS This was a retrospective cohort study at a tertiary care teaching hospital of women undergoing cesarean delivery with or without neuraxial clonidine administration while receiving chronic buprenorphine. The primary outcome was opioid consumption (in morphine milligram equivalents) 0-6 h following cesarean delivery. Secondary outcomes included opioid consumption 0-24 h post-cesarean, median postoperative pain scores 0-24 h, and rates of intraoperative anesthetic supplementation. Multivariable analysis evaluating the adjusted effects of neuraxial clonidine on outcomes was conducted using linear regression, proportional odds model, and logistic regression separately. RESULTS 196 women met inclusion criteria, of which 145 (74%) received neuraxial clonidine while 51 (26%) did not. In univariate analysis, there was no significant difference in opioid consumption 0-6 h post-cesarean delivery between the clonidine (8 [IQR 0, 15]) and control (1 [IQR 0, 8]) groups (P = 0.14). After adjusting for potential confounders, there remained no significant association with neuraxial clonidine administration 0-6 h (Difference in means 2.77, 95% CI [- 0.89 to 6.44], P = 0.14) or 0-24 h (Difference in means 8.56, 95% CI [- 16.99 to 34.11], P = 0.51). CONCLUSION In parturients receiving chronic buprenorphine therapy at the time of cesarean delivery, neuraxial clonidine administration was not associated with decreased postoperative opioid consumption, median pain scores, or the need for intraoperative supplementation.
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Affiliation(s)
- Michael G Taylor
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA.
- Department of Anesthesiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Jeanette R Bauchat
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
| | - Laura L Sorabella
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
| | - Jonathan P Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Xiaoke Feng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew S Shotwell
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Holly B Ende
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
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29
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Bello JK, Dell NA, Laxton AM, Conte M, Chen L. Prevalence and predictors of medication for opioid use disorder among reproductive-aged women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100239. [PMID: 38711835 PMCID: PMC11070671 DOI: 10.1016/j.dadr.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Background Women of reproductive age would benefit from treatment of opioid use disorder (OUD) prior to pregnancy to improve maternal and infant outcomes. In this study, we aimed to identify the prevalence of medication for OUD (MOUD) and characterize correlates of MOUD receipt among 12-49-year-old women with OUD seeking treatment in publicly funded substance use disorder treatment programs at the time of their first treatment episode. Methods This cross-sectional study explores the demographic and clinical characteristics of women of reproductive age with OUD receiving publicly funded substance use treatment services. We used data from the concatenated 2015-2021 Treatment Episode Data Set-Admissions (TEDS-A), which documents demographic and clinical characteristics of patient admissions to publicly funded substance use treatment services in the United States. Results In the sample of females aged 12-49 with no prior treatment admissions and primary OUD (n=325,512), 40.53% received MOUD (n=131,930), including 39.40% of non-pregnant women (n=115,315) and 52.79% of pregnant women (n=8423). Pregnant women had significantly higher odds of receiving MOUD (aOR = 2.42, 95%CI: 2.30, 2.54) compared to non-pregnant women. Non-white race, treatment setting, and treatment self-referral were also associated with higher levels of MOUD. Conclusions We identified a significant unmet need among both pregnant and non-pregnant women with OUD seeking care in publicly funded treatment clinics. While women who are pregnant are significantly more likely to receive evidence-based treatment with MOUD, still 47.21% of pregnant women did not receive MOUD. All reproductive-aged women with OUD should be offered evidence-based treatment options, including MOUD.
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Affiliation(s)
- Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Aaron M. Laxton
- School of Social Work, Saint Louis University, St. Louis, MO, USA
- Assisted Recovery Centers of America, St. Louis, MO, USA
| | - Mary Conte
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Lynn Chen
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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30
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Wiese AD, Phillippi JC, Muhar A, Polic A, Liu G, Loch SF, Ong HH, Su WC, Leech AA, Reese T, Wei WQ, Patrick SW. Performance of Phenotype Algorithms for the Identification of Opioid-Exposed Infants. Hosp Pediatr 2024; 14:438-447. [PMID: 38804051 PMCID: PMC11137624 DOI: 10.1542/hpeds.2023-007546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/23/2024] [Accepted: 02/03/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Observational studies examining outcomes among opioid-exposed infants are limited by phenotype algorithms that may under identify opioid-exposed infants without neonatal opioid withdrawal syndrome (NOWS). We developed and validated the performance of different phenotype algorithms to identify opioid-exposed infants using electronic health record data. METHODS We developed phenotype algorithms for the identification of opioid-exposed infants among a population of birthing person-infant dyads from an academic health care system (2010-2022). We derived phenotype algorithms from combinations of 6 unique indicators of in utero opioid exposure, including those from the infant record (NOWS or opioid-exposure diagnosis, positive toxicology) and birthing person record (opioid use disorder diagnosis, opioid drug exposure record, opioid listed on medication reconciliation, positive toxicology). We determined the positive predictive value (PPV) and 95% confidence interval for each phenotype algorithm using medical record review as the gold standard. RESULTS Among 41 047 dyads meeting exclusion criteria, we identified 1558 infants (3.80%) with evidence of at least 1 indicator for opioid exposure and 32 (0.08%) meeting all 6 indicators of the phenotype algorithm. Among the sample of dyads randomly selected for review (n = 600), the PPV for the phenotype requiring only a single indicator was 95.4% (confidence interval: 93.3-96.8) with varying PPVs for the other phenotype algorithms derived from a combination of infant and birthing person indicators (PPV range: 95.4-100.0). CONCLUSIONS Opioid-exposed infants can be accurately identified using electronic health record data. Our publicly available phenotype algorithms can be used to conduct research examining outcomes among opioid-exposed infants with and without NOWS.
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Affiliation(s)
- Andrew D. Wiese
- Departments of Health Policy
- Vanderbilt Center for Child Health Policy
| | - Julia C. Phillippi
- Vanderbilt Center for Child Health Policy
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | | | | | - Ge Liu
- Center for Precision Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Henry H. Ong
- Center for Precision Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wu-Chen Su
- Center for Precision Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley A. Leech
- Departments of Health Policy
- Vanderbilt Center for Child Health Policy
| | | | - Wei-Qi Wei
- Center for Precision Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen W. Patrick
- Departments of Health Policy
- Pediatrics
- Vanderbilt Center for Child Health Policy
- Mildred Stahlman Division of Neonatology
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31
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Perez C. Transitioning Care Approach for Neonatal Opioid Withdrawal Syndrome and Neonatal Abstinence Syndrome. Crit Care Nurs Clin North Am 2024; 36:223-233. [PMID: 38705690 DOI: 10.1016/j.cnc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The increase in substance use during pregnancy results in a higher incidence of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), straining health care and social systems and creating an economic burden. There is a paradigm shift in transitioning the care approach for NAS/NOWS from a medical model of care to a family-centered individualized non-pharmacological care approach with non-pharmacological interventions as the first line of treatment. Supporting families after birth with a nurturing environment and providing them with a toolbox of non-pharmacological interventions prepares them for the transition from hospital to home.
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Affiliation(s)
- Christine Perez
- NICU Thought Leader Philips, Infant Massage USA, 8800 Lombard Place 1507, San Diego, CA 92122, USA.
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32
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Cardin AD. Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome: An Ecological View of Non-Pharmacologic Interventions for Feeding Success. Crit Care Nurs Clin North Am 2024; 36:235-249. [PMID: 38705691 DOI: 10.1016/j.cnc.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The number of infants diagnosed with neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) has increased. The expression of NAS/NOWS symptoms differs and typically begins within the first few days of life, considered a critical period for feeding skill establishment, nourishment, and attachment. Non-pharmacologic interventions may be deployed to reduce or eliminate the need for replacement opioids while targeting outcomes like feeding dysfunction. Critical care providers can benefit from a structured examination of disordered feeding experiences to inform their selection of non-pharmacologic interventions. This structure can be provided using the Ecology of Human Performance model.
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Affiliation(s)
- Ashlea D Cardin
- Missouri State University, 901 S. National Avenue, OCHS 203H, Springfield, MO 65897, USA.
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He Y, Chaiyachati BH, Matone M, Bastos S, Kallem S, Mehta A, Wood JN. "Instead of just taking my baby, they could've actually given me a chance": Experiences with plans of safe care among birth parents impacted by perinatal substance use. CHILD ABUSE & NEGLECT 2024; 152:106798. [PMID: 38615413 PMCID: PMC11206134 DOI: 10.1016/j.chiabu.2024.106798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/05/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Federal legislation mandates healthcare providers to notify child protective service (CPS) agencies and offer a voluntary care plan called a "plan of safe care" (POSC) for all infants born affected by prenatal substance use. While POSCs aim to provide supportive services for families impacted by substance use, little is known about birth parents' perceptions and experiences. OBJECTIVE To examine birth parents' perceptions and experiences regarding POSC. PARTICIPANTS AND SETTING Parents offered a POSC in Philadelphia in the prior year were included. METHODS This is a qualitative interview study. Participants were recruited from birth hospitals and community-based programs with telephone consent and interview procedures. Transcripts were analyzed using an inductive, grounded theory approach to identify content themes. RESULTS Twelve birth parents were interviewed (30.7 % of eligible, contacted individuals). Fear of CPS involvement and stigma were common. Some birth parents reported that the increased scrutiny related to POSCs negatively impacted their attitudes toward healthcare providers and medications for opioid use disorder (MOUD). While parents found the consolidated resource information helpful, many did not know how to access services. Finally, parents desired more individualized plans tailored to their unique family needs. CONCLUSIONS Stigma, confusion, and fear of CPS involvement undermine the goal of POSCs to support substance-exposed infants and birth parents. Providers serving this population should be transparent regarding CPS notifications, provide compassionate, non-stigmatizing care, and offer coordination services to support engagement after discharge. Policymakers should consider separating POSCs from CPS to avoid exacerbating fear and mistrust.
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Affiliation(s)
- Yuan He
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Barbara H Chaiyachati
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America; Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Shelley Bastos
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Stacey Kallem
- Philadelphia Department of Public Health, Philadelphia, PA, United States of America
| | - Aasta Mehta
- Philadelphia Department of Public Health, Philadelphia, PA, United States of America
| | - Joanne N Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America; Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
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Kim K, Liu G, Dick AW, Choi SW, Agbese E, Corr TE, Hsuan C, Wright MS, Park S, Velott D, Leslie DL. Timing of treatment for opioid use disorder among birthing people. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209289. [PMID: 38272119 PMCID: PMC11090704 DOI: 10.1016/j.josat.2024.209289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated. METHODS Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people. RESULTS Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32). CONCLUSION Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
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Affiliation(s)
- Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Sung W Choi
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tammy E Corr
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Charleen Hsuan
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Megan S Wright
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Law, University Park, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Sujeong Park
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Diana Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Kaufman JS, Yonkers KA, Maltz C, Friedhoff CM, Londoño Tobon A, Mele A, Tessier-Kay M, Grechukhina O, Lipkind H, Byatt N, Forray A. Reporting Perinatal Substance Use to Child Protective Services: Obstetric Provider Perspectives on the Impact on Care. J Womens Health (Larchmt) 2024. [PMID: 38770764 DOI: 10.1089/jwh.2023.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392.
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Affiliation(s)
- Joy S Kaufman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Yonkers
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Caro Maltz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carolyn M Friedhoff
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amalia Londoño Tobon
- Department of Psychiatry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Amanda Mele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Olga Grechukhina
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Heather Lipkind
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Dwivedi I, Haddad GG. Investigating the neurobiology of maternal opioid use disorder and prenatal opioid exposure using brain organoid technology. Front Cell Neurosci 2024; 18:1403326. [PMID: 38812788 PMCID: PMC11133580 DOI: 10.3389/fncel.2024.1403326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024] Open
Abstract
Over the past two decades, Opioid Use Disorder (OUD) among pregnant women has become a major global public health concern. OUD has been characterized as a problematic pattern of opioid use despite adverse physical, psychological, behavioral, and or social consequences. Due to the relapsing-remitting nature of this disorder, pregnant mothers are chronically exposed to exogenous opioids, resulting in adverse neurological and neuropsychiatric outcomes. Collateral fetal exposure to opioids also precipitates severe neurodevelopmental and neurocognitive sequelae. At present, much of what is known regarding the neurobiological consequences of OUD and prenatal opioid exposure (POE) has been derived from preclinical studies in animal models and postnatal or postmortem investigations in humans. However, species-specific differences in brain development, variations in subject age/health/background, and disparities in sample collection or storage have complicated the interpretation of findings produced by these explorations. The ethical or logistical inaccessibility of human fetal brain tissue has also limited direct examinations of prenatal drug effects. To circumvent these confounding factors, recent groups have begun employing induced pluripotent stem cell (iPSC)-derived brain organoid technology, which provides access to key aspects of cellular and molecular brain development, structure, and function in vitro. In this review, we endeavor to encapsulate the advancements in brain organoid culture that have enabled scientists to model and dissect the neural underpinnings and effects of OUD and POE. We hope not only to emphasize the utility of brain organoids for investigating these conditions, but also to highlight opportunities for further technical and conceptual progress. Although the application of brain organoids to this critical field of research is still in its nascent stages, understanding the neurobiology of OUD and POE via this modality will provide critical insights for improving maternal and fetal outcomes.
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Affiliation(s)
- Ila Dwivedi
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Gabriel G. Haddad
- Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Rady Children’s Hospital, San Diego, CA, United States
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Berger LM, Durrance C, Ehrenthal D, Kim H, Kuo HH, Pac J. Prenatal opioid exposure by likelihood of exposure and risk to prenatal development: Medicaid-covered births in Wisconsin, 2010-2019. SCIENCE ADVANCES 2024; 10:eadg9674. [PMID: 38718116 PMCID: PMC11078186 DOI: 10.1126/sciadv.adg9674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024]
Abstract
Prenatal opioid exposure is an established public health problem, in particular among Medicaid-covered births. Yet, existing prevalence rates are plausibly underestimated. We leverage extensive linked longitudinal administrative data for all Medicaid-covered live births in Wisconsin from 2010 to 2019 to estimate a range of prevalence rates using an innovative strategy that jointly accounts for both likelihood of exposure and potential risk to prenatal development. We find that 20.8% of infants may have been prenatally exposed to opioids, with 1.7% diagnosed with neonatal abstinence syndrome and an additional 1.2% having a high combined likelihood of exposure and potential risk to prenatal development, 2.6% a moderate combined likelihood and risk, and 15.3% a low or uncertain combined likelihood and risk. We assess improvements in prevalence estimates based on our nuanced classification relative to those of prior studies. Our strategy could be broadly used to quantify the scope of the opioid crisis for pregnant populations, target interventions, and promote child health and development.
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Affiliation(s)
- Lawrence M. Berger
- Sandra Rosenbaum School of Social Work and Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Christine Durrance
- Robert M. LaFollette of Public Affairs and Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Deborah Ehrenthal
- Department of Biobehavioral Health and Social Science Research Institute, Pennsylvania State University, University Park, PA 16802, USA
| | - HeeJin Kim
- Sandra Rosenbaum School of Social Work and Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Hsiang-Hui Kuo
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Jessica Pac
- Sandra Rosenbaum School of Social Work and Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI 53706, USA
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Jilani SM, Davis JM, Goldstein D, Grossman M, Jansson LM, Terplan M, Jones HE. Clinically defining the opioid-exposed birthing person and infant as a dyad to support bedside care, surveillance, and research. Front Pediatr 2024; 12:1349102. [PMID: 38774300 PMCID: PMC11106404 DOI: 10.3389/fped.2024.1349102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction An increased incidence of maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) has prompted recommendations supporting a dyadic approach to care for birthing persons and their infants. However, there are no consensus guidelines outlining how the dyad is clinically defined. Methods To examine how the opioid-exposed birthing person-infant dyad has been defined for purposes of data collection and research, a literature review applying the RAND/UCLA Appropriateness Method was conducted. Results The search yielded 320 abstracts, with 110 articles identified as having a dyadic focus. While no articles included a specific definition for the dyad, 33 (30%) contained a descriptive reference to the birthing person-infant dyad. Thematic analysis revealed eight recurring elements characteristic of the dyad: (1) engagement, (2) communication, (3) bonding, (4) attachment, (5) mutual responsiveness, (6) reciprocity, (7) synchrony, and (8) attunement. Integrating these elements revealed the interactional relationship between the opioid-exposed birthing person and infant as the foundational principle that defines the dyad. Discussion This definition shifts the focus of the opioid-exposed dyad from two individual patient populations to an interactional relationship that has broad applicability for clinical use, public health data collection, and research considerations.
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Affiliation(s)
- Shahla M. Jilani
- Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, DC, United States
| | - Jonathan M. Davis
- Division of Newborn Medicine, Tufts Medical Center, Boston, MA, United States
- The Tufts Clinical and Translational Science Institute, Boston, MA, United States
| | - David Goldstein
- Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, DC, United States
| | - Matthew Grossman
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Lauren M. Jansson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Addiction and Pregnancy, Baltimore, MD, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | - Hendrée E. Jones
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Meinhofer A, Chandra N, Byanova D, Keyes KM. Foster Care and Health in Medicaid-Enrolled Children Experiencing Parental Opioid Use Disorder. JAMA Netw Open 2024; 7:e2410432. [PMID: 38717771 PMCID: PMC11079692 DOI: 10.1001/jamanetworkopen.2024.10432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/08/2024] [Indexed: 05/12/2024] Open
Abstract
Importance The burden of the US opioid crisis has fallen heavily on children, a vulnerable population increasingly exposed to parental opioid use disorder (POUD) in utero or during childhood. A paucity of studies have investigated foster care involvement among those experiencing parental opioid use during childhood and the associated health and health care outcomes. Objective To examine the health and health care outcomes of children experiencing POUD with and without foster care involvement. Design, Setting, and Participants This population-based cohort study used nationwide Medicaid claims data from January 1, 2014, to December 31, 2020. Participants included Medicaid-enrolled children experiencing parental opioid use-related disorder during ages 4 to 18 years. Data were analyzed between January 2023 and February 2024. Exposure Person-years with (exposed) and without (nonexposed) foster care involvement, identified using Medicaid eligibility, procedure, and diagnostic codes. Main Outcomes and Measures The main outcomes included physical and mental health conditions, developmental disorders, substance use, and health care utilization. The Pearson χ2 test, the t test, and linear regression were used to compare outcomes in person-years with (exposed) and without (nonexposed) foster care involvement. An event study design was used to examine health care utilization patterns before and after foster care involvement. Results In a longitudinal sample of 8 939 666 person-years from 1 985 180 Medicaid-enrolled children, 49% of children were females and 51% were males. Their mean (SD) age was 10 (4.2) years. The prevalence of foster care involvement was 3% (276 456 person-years), increasing from 1.5% in 2014 to 4.7% in 2020. Compared with those without foster care involvement (8 663 210 person-years), foster care involvement was associated with a higher prevalence of developmental delays (12% vs 7%), depression (10% vs 4%), trauma and stress (35% vs 7%), and substance use-related disorders (4% vs 1%; P < .001 for all). Foster children had higher rates of health care utilization across a wide array of preventive services, including well-child visits (64% vs 44%) and immunizations (41% vs 31%; P < .001 for all). Health care utilization increased sharply in the first year entering foster care but decreased as children exited care. Conclusions and Relevance In this cohort study of Medicaid-enrolled children experiencing parental opioid use-related disorder, foster care involvement increased significantly between 2014 and 2020. Involvement was associated with increased rates of adverse health outcomes and health care utilization. These findings underscore the importance of policies that support children and families affected by opioid use disorder, as well as the systems that serve them.
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Affiliation(s)
- Angélica Meinhofer
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Nisha Chandra
- Medical College, Weill Cornell Medicine, New York, New York
| | | | - Katherine M. Keyes
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York
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Sankaran D, Rawat S, Kachelmeyer JL, Li ES, Reynolds AM, Rawat M, Chandrasekharan P. Severe Neonatal Opioid Withdrawal Requiring Pharmacotherapy: Impact of Region of Residence. Am J Perinatol 2024; 41:e654-e663. [PMID: 35973797 DOI: 10.1055/a-1925-1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Our objective was to evaluate the trend and to assess the impact of maternal region of residence in Western New York (WNY), on severe neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN Term infants' born at gestational age greater than or equal to 37 weeks with severe NOWS, defined as withdrawal resulting in the receipt of pharmacologic therapy from WNY admitted to our neonatal intensive care unit (NICU) from January 1, 2008 to December 31, 2016, were included. Severe NOWS admissions to our NICU from the following five regions were controlled with birth and insurance data: (1) Urban North, (2) Erie Coastal, (3) Niagara Frontier, (4) Southern Tier, and (5) Urban South. RESULTS "Urban South" residence was associated with an increased risk of severe NOWS (adjusted odds ratio = 1.8, 97.5% confidence interval: 1.1-2.9). The trend in admission for severe NOWS doubled between 2008 to 2010 and 2014 to 2016 (p = 0.01). More infants born to maternal nonprescribed opioid users were placed in foster care at discharge (36.5 vs. 1.9%, p < 0.001). CONCLUSION In WNY, neonates born to mothers from the "Urban South" were twice at risk of being admitted for severe NOWS. One-third of infants with severe NOWS after nonprescribed opioid use were placed in foster care. Implementing targeted strategies at the community level may help improve outcomes in NOWS. KEY POINTS · Maternal region of residence is a risk factor for severe neonatal opioid withdrawal.. · Admissions for severe neonatal opioid withdrawal trended up from 2008 to 2010 to 2014 to 2016.. · One-third of the infants born to mothers on nonprescribed opioids were discharged to foster care..
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Affiliation(s)
- Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
- Division of Neonatology, Department of Pediatrics, University of California at Davis, Sacramento, California
| | - Shikha Rawat
- Department of Economics, Stony Brook University, Stony Brook, New York
- Research Analyst, American Express, New York, New York
| | - Jennifer L Kachelmeyer
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Emily S Li
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Anne M Reynolds
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Munmun Rawat
- Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
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DiPietro B, Silcox K, Rost J, Woods LS, Edwards EM, Buus-Frank ME, Horbar JD, Hudak ML. Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in Maryland. Am J Perinatol 2024; 41:e22-e29. [PMID: 35381608 DOI: 10.1055/a-1817-5522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES A statewide Maryland Perinatal Neonatal Quality Collaborative, facilitated by the Maryland Patient Safety Center (MPSC), identified the three specific, measurable, attainable, relevant, and time-limited (SMART) aims to improve outcomes of neonatal abstinence syndrome (NAS) care as follows: (1) to reduce hospital length of stay (LOS), (2) to reduce interhospital transfers, and (3) to reduce 30-day readmission rates of infants with NAS. STUDY DESIGN The Maryland collaborative developed a bundle of best practices for care of infants with NAS. MPSC partnered with Vermont Oxford Network (VON) to utilize the VON NAS toolkit and provided its standardized NAS educational curriculum to address the three objectives for participating birthing hospitals. Efforts began in quarter 4 (Q4) of 2016 and continued for 2 years. Thirty-one of Maryland's 32 delivery hospitals (97%) participated in the 2-year collaborative. Additionally, one specialty pediatric hospital with an NAS unit participated in the group learnings. Participating facilities implemented components of the MPSC NAS bundle and provided their staff caring for infants with NAS and their mothers access to the VON standardized educational curriculum. MPSC partnered with VON to conduct two audits of implementation of policies and procedures in Q1 of 2016 and Q3 of 2018. The Maryland Department of Health supplied quarterly aggregate hospital information on LOS, interhospital transfers, and 30-day readmissions of infants with a discharge diagnosis of the International Classification of Disease, 10th Revision (ICD-10), P96.1. RESULTS Among term infants with NAS with total hospital stay greater than 5 days, we observed a nonsignificant reduction in both mean and median LOS of 1.5 days. In this same group, the rate of interhospital transfers fell significantly from 20.1% in 2016 to 13.8 and 11.0% in 2017 and 2018, respectively. CONCLUSION The best practice bundle created by the Maryland collaborative was associated with a reduction in the percentage of infants with NAS who required interhospital transfer, thereby reducing family disruption. KEY POINTS · A state NAS collaborative engaged 97% of delivery hospitals in education and standardization of care.. · The collaborative witnessed a 1.5-day decrease in length of stay, similar to that observed in other state collaboratives.. · The unique outcome of our collaborative was a 50% decrease in the rate of interhospital transfer..
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Affiliation(s)
| | - Kristin Silcox
- Maryland Department of Health,Prevention and Health Promotion Administration, Maternal and Child Health Bureau, Baltimore, Maryland
| | - James Rost
- Adventist Healthcare White Oak Medical Center, Silver Spring, Maryland
| | - Lee S Woods
- Maryland Department of Health,Prevention and Health Promotion Administration, Maternal and Child Health Bureau, Baltimore, Maryland
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
| | - Madge E Buus-Frank
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH and The Children's Hospital at Dartmouth, Lebanon, New Hampshire
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington, Vermont
| | - Mark L Hudak
- Division of Neonatology, Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, Florida
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Bhatt P, Ampem-Darko C, Cudjoe GA, Parmar N, Oredein I, Asiama AO, Patel J, Pemmasani S, Linga VG, Donda K, Doshi H, Dapaah-Siakwan F. Association between Neonatal Abstinence Syndrome and Congenital Anomalies in the United States. Am J Perinatol 2024; 41:e1023-e1029. [PMID: 36572036 DOI: 10.1055/s-0042-1759864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Studies exploring the relationship between neonatal abstinence syndrome (NAS) and congenital anomalies (CA) in the United States are limited given the small sample size or data prior to the opioid epidemic. We aimed to determine if there is an association between NAS and CA in a nationally representative cohort of newborn hospitalization in the United States. STUDY DESIGN This was a cross-sectional analysis of NAS-related hospitalizations within the 2016 Kids Inpatient Database. International Classification of Diseases (ICD-10-CM) diagnostic codes were used to identify NAS hospitalizations and those with and without CA. The primary outcome was the odds of CAs in NAS hospitalizations. Multivariate survey logistic regression was used to analyze the relationship between NAS and CA. RESULTS Among 3.7 million newborn hospitalizations, 25,394 had NAS (6.7 per 1,000). The prevalence of any CA was higher in those with NAS when compared with non-NAS hospitalizations (10.3 vs. 4.9%; odds ratio = 2.27; 95% confidence interval [CI]: 2.13-2.43). Adjusted analysis showed similar results (adjusted odds ratio: = 1.83, CI: 1.71-1.95). NAS hospitalizations with CA had a higher mortality rate (0.6 vs 0.04%, p < 0.0001) and higher resource use. CONCLUSION This nationwide study shows that NAS may be associated with increased odds of CAs, suggesting that NAS may be a risk factor for increased morbidity in the newborn period. KEY POINTS · 1 in 10 newborns with NAS had at least one congenital anomaly.. · NAS hospitalization with congenital anomalies had higher resource use and mortality.. · Pediatricians caring for newborns with NAS should have a high index of suspicion for birth defects..
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Affiliation(s)
- Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
| | | | - Grace Annan Cudjoe
- Department of Pediatrics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Narendrasinh Parmar
- Section of Emergency Medicine, East Tennessee Children's Hospital, Knoxville, Tennessee
| | | | - Adwoa O Asiama
- Department of Medicine, Pantang Hospital, Accra, Greater Accra, Ghana
| | - Jenil Patel
- Center for Pediatric and Population Health, School of Public Health, University of Texas Health Science Center at Houston (UT Health), Texas
| | - Sahithi Pemmasani
- Pediatric Residency Program, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York
| | - Vijay Gandhi Linga
- Department of Pediatrics, San Juan Regional Medical Center, Farmington, New Mexico
| | - Keyur Donda
- Division of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Harshit Doshi
- Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida
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Doshi H, Shukla S, Patel S, Cudjoe GA, Boakye W, Parmar N, Bhatt P, Dapaah-Siakwan F, Donda K. National Trends in Survival and Short-Term Outcomes of Periviable Births ≤24 Weeks Gestation in the United States, 2009 to 2018. Am J Perinatol 2024; 41:e94-e102. [PMID: 35523408 DOI: 10.1055/a-1845-2526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Data from the academic medical centers in the United States showing improvements in survival of periviable infants born at 22 to 24 weeks GA may not be nationally representative since a substantial proportion of preterm infants are cared for in community hospital-based neonatal intensive care units. Our objective was to examine the national trends in survival and other short-term outcomes among preterm infants born at ≤24 weeks gestational age (GA) in the United States from 2009 to 2018. STUDY DESIGN This was a retrospective, repeated cross-sectional analysis of the National Inpatient Sample for preterm infants ≤24 weeks GA. The primary outcome was the trends in survival to discharge. Secondary outcomes were the trends in the composite outcome of death or one or more major morbidity (bronchopulmonary dysplasia, necrotizing enterocolitis stage ≥2, periventricular leukomalacia, severe intraventricular hemorrhage, and severe retinopathy of prematurity). The Cochran-Armitage trend test was used for trend analysis. p-Value <0.05 was considered significant. RESULTS Among 71,854 infants born at ≤24 weeks GA, 34,251 (47.6%) survived less than 1 day and were excluded. Almost 93% of those who survived <1 day were of ≤23 weeks GA. Among the 37,603 infants included in the study cohort, 48.1% were born at 24 weeks GA. Survival to discharge at GA ≤ 23 weeks increased from 29.6% in 2009 to 41.7% in 2018 (p < 0.001), while survival to discharge at GA 24 weeks increased from 58.3 to 65.9% (p < 0.001). There was a significant decline in the secondary outcomes among all the periviable infants who survived ≥1 day of life. CONCLUSION Survival to discharge among preterm infants ≤24 weeks GA significantly increased, while death or major morbidities significantly decreased from 2009 to 2018. The postdischarge survival, health care resource use, and long neurodevelopmental outcomes of these infants need further investigation. KEY POINTS · Survival increased significantly in infants ≤24 weeks GA in the United States from 2009 to 2018.. · Death or major morbidity in infants ≤24 weeks GA decreased significantly from 2009 to 2018.. · Death or surgical procedures including tracheostomy, VP shunt placement, and PDA surgical closure in infants <=24 weeks GA decreased significantly from 2009 to 2018..
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Affiliation(s)
- Harshit Doshi
- Neonatal Intensive Care Unit, Golisano Children's Hospital of Southwest Florida, Florida
| | - Samarth Shukla
- University of Florida College of Medicine, Jacksonville, Florida
| | | | | | - Wendy Boakye
- National Institute of Health, Bethesda, Maryland
| | - Narendrasinh Parmar
- Department of Pediatrics Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
| | | | - Keyur Donda
- Department of Pediatrics/Division of Neonatology University of South Florida, Tampa, Florida
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Mason I, Abdelwahab M, Stiles A, Wu J, Venkatesh KK, Rood KM. Association between Individual versus Community-level Social Vulnerability and Neonatal Opioid Withdrawal Syndrome among Pregnant Individuals Receiving Buprenorphine for Opioid Use Disorder. Am J Perinatol 2024; 41:e3157-e3163. [PMID: 37890511 DOI: 10.1055/a-2200-3187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Individual patient-level measures of adverse social determinants of health are associated with neonatal opioid withdrawal syndrome (NOWS), but the relative impact of community-level adverse social determinants of health remains to be defined. We examined the association between community-level social vulnerability and NOWS among pregnant individuals receiving buprenorphine for opioid use disorder. STUDY DESIGN We conducted a secondary analysis of an established cohort of pregnant individuals and their infants participating in a multidisciplinary prenatal/addiction care program from 2013 to 2021. Addresses were geocoded using ArcGIS and linked at the census tract to the Centers for Disease Control and Prevention 2018 Social Vulnerability Index (SVI), incorporating 15 census variables. The primary exposure was the SVI as a composite measure of community-level social vulnerability, and secondarily, individual scores for four thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). The primary outcome was a clinical diagnosis of NOWS defined as withdrawal requiring pharmacological treatment following buprenorphine exposure. RESULTS Among 703 pregnant individuals receiving buprenorphine, 39.8% (280/703) of infants were diagnosed with NOWS. Among our patinets, those who were nulliparous, had post-traumatic stress disorder, a term birth (≥ 37 weeks) and had a male infant were more likely to have an infant diagnosed with NOWS. Individuals with and without an infant diagnosed with NOWS had similarly high community-level social vulnerability per composite SVI scores (mean [standard deviation]: 0.6 [0.4-0.7] vs. 0.6 [0.4-0.7], p = 0.2]. In adjusted analyses, SVI, as a composite measure as well as the four domains, was not associated with NOWS diagnosis. CONCLUSION Among pregnant persons receiving buprenorphine enrolled in a multidisciplinary prenatal and addition care program, while individual risk factors that measure adverse social determinants of health were associated with an NOWS diagnosis in the infant, community-level social vulnerability as measured by the SVI was not associated with the outcome. KEY POINTS · Community-level SVI was not associated with neonatal opioid use disorder.. · Certain individual risk factors were identified as being associated with NOWS.. · Homogeneity of composite SVI scores may have led to lack of significant findings..
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Affiliation(s)
- Isabelle Mason
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mahmoud Abdelwahab
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alexandra Stiles
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jiqiang Wu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kara M Rood
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Ferrante JR, Blendy JA. Advances in animal models of prenatal opioid exposure. Trends Neurosci 2024; 47:367-382. [PMID: 38614891 PMCID: PMC11096018 DOI: 10.1016/j.tins.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024]
Abstract
Neonatal opioid withdrawal syndrome (NOWS) is a growing public health concern. The complexity of in utero opioid exposure in clinical studies makes it difficult to investigate underlying mechanisms that could ultimately inform early diagnosis and treatments. Clinical studies are unable to dissociate the influence of maternal polypharmacy or the environment from direct effects of in utero opioid exposure, highlighting the need for effective animal models. Early animal models of prenatal opioid exposure primarily used the prototypical opioid, morphine, and opioid exposure that was often limited to a narrow period during gestation. In recent years, the number of preclinical studies has grown rapidly. Newer models utilize both prescription and nonprescription opioids and vary the onset and duration of opioid exposure. In this review, we summarize novel prenatal opioid exposure models developed in recent years and attempt to reconcile results between studies while critically identifying gaps within the current literature.
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Affiliation(s)
- Julia R Ferrante
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie A Blendy
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Doernberg M, Gilstad-Hayden K, Yonkers KA, Forray A. Provider-patient relationships and trauma among pregnant patients with opioid-use disorder. Am J Addict 2024. [PMID: 38685767 DOI: 10.1111/ajad.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The provider-patient relationship is integral to medical practice and health outcomes, particularly among vulnerable patient populations. This study compared the provider-patient relationship among pregnant patients with opioid-use disorder (OUD), who did or did not have a history of moderate to severe trauma. METHODS This was an exploratory data analysis of 119 patients enrolled in the Support Models for Addiction Related Treatment trial. Probable posttraumatic stress disorder (PTSD) was determined by a score ≥ 31 on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The provider-patient relationship was assessed at 26 ± 4 weeks of pregnancy using the Kim Alliance Scale (KAS). Multivariable regression was used to examine the association of KAS with probable PTSD among pregnant people with OUD. RESULTS The mean KAS score for pregnant participants without probable PTSD (N = 88) was 61.4 (SD ± 2.8) and for pregnant participants with probable PTSD (N = 31) was 59.6 (SD ± 3.7). Results demonstrated significant differences in KAS scores between those with and without probable PTSD after adjusting for demographic variables. Adjusted mean total KAS scores and scores on Empowerment and Communication subscales were significantly lower among those with probable PTSD compared to those without (p = .04 and 0.02, respectively) but did not differ significantly on Collaboration and Integration subscales. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Analyses show an association between probable PTSD and provider-patient relationship among pregnant patients with OUD, with those with probable PTSD having a worse alliance with obstetric providers. This novel finding helps characterize the provider-patient relationship among a uniquely vulnerable population and can inform efforts to integrate trauma-informed practices into prenatal care.
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Affiliation(s)
| | | | - Kimberly A Yonkers
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Wen X, Brothers T, Ward KE, Kogut S. Reducing the risks of prenatal opioid exposure in children. BMJ 2024; 385:q803. [PMID: 38658037 DOI: 10.1136/bmj.q803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Xuerong Wen
- Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Todd Brothers
- Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Kristina E Ward
- Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Stephen Kogut
- Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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Smith D, Sullivan R, Allen EC, Pradhan S, Zhu J, Oji-Mmuo CN. Evaluating the Effect of Maternal Opioid Maintenance Dose on the NOWS-COS Outcome Criteria: A Pilot Study. Clin Pediatr (Phila) 2024:99228241246647. [PMID: 38629767 DOI: 10.1177/00099228241246647] [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] [Indexed: 06/23/2024]
Abstract
This retrospective cohort study included 77 mother-infant dyads that delivered term pregnancies at a single tertiary care institution. The primary objective was to investigate whether maternal dose of opioid maintenance therapy during pregnancy affects infant outcomes. All infants had prenatal exposure to opioid maintenance therapies. Maternal dose was converted into morphine milligram equivalents (MMEs) and stratified into high- (MME >1000 mg) and low-dose groups (MME ≤1000 mg). Associations between infant outcomes and MME dosage were examined using Wilcoxon rank-sum and Fisher's Exact tests. Days to symptom control were significantly higher in the high MME group (5 days vs 2.8 days, P = .016). Rates of developmental delay at 24 months were higher in the high MME group (21.2% vs 4.5%, P = .0335). Maternal MME did not predict need for NOWS treatment. Higher MME-exposed infants should have optimized nonpharmacologic interventions for consolation and be increasingly observed for signs of developmental delay.
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Affiliation(s)
- Danielle Smith
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Rhea Sullivan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Emma C Allen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christiana N Oji-Mmuo
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Alur P, Holla I, Hussain N. Impact of sex, race, and social determinants of health on neonatal outcomes. Front Pediatr 2024; 12:1377195. [PMID: 38655274 PMCID: PMC11035752 DOI: 10.3389/fped.2024.1377195] [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: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.
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Affiliation(s)
- Pradeep Alur
- Penn State College of Medicine, Hampden Medical Center, Enola, PA, United States
| | - Ira Holla
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Naveed Hussain
- Department of Pediatrics, Connecticut Children’s, Hartford, CT, United States
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Hite MK, Chroust AJ, Proctor-Williams K, Lowe JL. Newborn Hearing Screening Results for Infants With Prenatal Opioid Exposure in Southern Appalachia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1268-1280. [PMID: 38517271 DOI: 10.1044/2024_jslhr-23-00492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE Infants prenatally exposed to opioids exhibit withdrawal symptomology that introduce physiological noise and can impact newborn hearing screening results. This study compared the referral rate and physiological noise interpreted by number of trials rejected due to artifact on initial newborn hearing screenings of infants with prenatal opioid exposure (POE) and infants with no opioid exposure (NOE). Furthermore, within the POE group, it examined the relationship of referral rates with severity of withdrawal symptomology, and with maternal and infant risk factors. METHOD This study used a retrospective cohort design of electronic medical records from six delivery hospitals in South-Central Appalachia. Newborn hearing screenings were conducted using automated auditory brainstem response (ABR) for 334 infants with POE and 226 infants with NOE. Severity of withdrawal symptomology was measured using the Modified Finnegan Neonatal Abstinence Scoring Tool, which includes observation of behaviors that introduce physiological noise. RESULTS There was no significant difference in newborn hearing screening referral rate between infants with POE and infants with NOE. Referral rate was not affected by maternal or infant risk factors. Infants with POE had statistically significant higher artifact (defined as rejected ABR sweeps) than infants with NOE. There was a strong positive correlation between Finnegan scores and artifact but not referral rates. Sensitivity and specificity analysis indicated artifact decreased substantially after Day 4 of life. CONCLUSIONS Referral rates of infants with POE were similar to those of infants with NOE. Nevertheless, the withdrawal symptomology of infants with POE introduces physiological noise reflected as artifact on ABR, which can affect efficiency of newborn hearing screenings.
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Affiliation(s)
- Marcy K Hite
- Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City
| | - Alyson J Chroust
- Department of Psychology, East Tennessee State University, Johnson City
| | - Kerry Proctor-Williams
- Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City
| | - Jennifer L Lowe
- Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City
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