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Elmore AL, Salemi JL, Kirby RS, Sappenfield WM, Lowry J, Dixon A, Lake-Burger H, Tanner JP. Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida. Matern Child Health J 2023; 27:44-51. [PMID: 37199857 PMCID: PMC10692249 DOI: 10.1007/s10995-023-03669-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associations between maternal/hospital characteristics and diagnosis with an opioid-related code. METHODS To identify people with prenatal opioid use, we identified a sample of infants born during 2017-2018 in Florida with a NAS related diagnosis code (P96.1) and confirmatory NAS characteristics (N = 460). Delivery records were scanned for opioid-related diagnoses and prenatal opioid use was confirmed through record review. The accuracy of each opioid-related code was measured using positive predictive value (PPV) and sensitivity. Modified Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI). RESULTS We found the PPV was nearly 100% for all ICD-10-CM opioid-related codes (98.5-100%) and the sensitivity was 65.9%. Non-Hispanic Black mothers were 1.8 times more likely than non-Hispanic white mothers to have a missed opioid-related diagnosis at delivery (aRR:1.80, CI 1.14-2.84). Mothers who delivered at a teaching status hospital were less likely to have a missed opioid-related diagnosis (p < 0.05). CONCLUSIONS FOR PRACTICE We observed high accuracy of maternal opioid-related diagnosis codes at delivery. However, our findings suggest that over 30% of mothers with opioid use may not be diagnosed with an opioid-related code at delivery, although their infant had a confirmed NAS diagnosis. This study provides information on the utility and accuracy of ICD-10-CM opioid-related codes at delivery among mothers of infants with NAS.
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Affiliation(s)
- Amanda L Elmore
- Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612-3805, USA.
| | - Jason L Salemi
- Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612-3805, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612-3805, USA
| | - William M Sappenfield
- Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612-3805, USA
| | - Joseph Lowry
- Florida Department of Health, Florida Birth Defects Registry, Tallahassee, USA
| | - Ashley Dixon
- Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612-3805, USA
| | - Heather Lake-Burger
- Florida Department of Health, Florida Birth Defects Registry, Tallahassee, USA
| | - Jean Paul Tanner
- Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612-3805, USA
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Abstract
BACKGROUND/SIGNIFICANCE Intrauterine opioid drug exposure is associated with an increased risk of preterm birth. Preterm infants may not exhibit the same withdrawal symptoms as term infants diagnosed with neonatal abstinence syndrome (NAS). There are no current standards for how to screen, assess, or treat NAS in preterm infants. PURPOSE This study explored the current state of practice for preterm infants born at less than 34 weeks of gestational age exposed to intrauterine opioids. METHODS This was a descriptive cross-sectional study of NAS practice in preterm infants born at less than 34 weeks of gestational age in neonatal intensive care units (NICUs) in the United States and Canada. The study was conducted May through September 2018. All respondents cared for preterm infants born at less than 34 weeks of gestational age exposed to intrauterine drugs. RESULTS There were 70 respondents representing 67 hospitals in the United States and 1 in Canada. Level III NICUs represented 69% of respondents. Ninety-three percent reported neonatal triggers for further evaluation. Review of maternal history and maternal urine testing was the most consistent practice across NICUs. A modified Finnegan scoring tool was used for both preterm and term infants. Morphine was reported as the most common first-line drug used for treatment. IMPLICATIONS FOR PRACTICE Great variability in NAS practice for preterm infants born at less than 34 weeks of gestational age across the multiple NICUs supports the need for a validated preterm infant assessment tool and development of appropriate treatment strategies. IMPLICATIONS FOR RESEARCH Future research describing the NAS symptomatology of preterm infants born at less than 34 weeks of gestational age exposed to intrauterine opioids is warranted.
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Nguyen NH, Le EN, Mbah VO, Welsh EB, Daas R, Spooner KK, Salemi JL, Olaleye OA, Salihu HM. Opioid Use Among HIV-Positive Pregnant Women and the Risk for Maternal-Fetal Complications. South Med J 2020; 113:292-297. [PMID: 32483639 DOI: 10.14423/smj.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess patient- and hospital-level characteristics associated with opioid use in human immunodeficiency virus (HIV)-positive pregnant women and fetal health outcomes. METHODS Using the 2002-2014 Nationwide Inpatient Sample database, we analyzed discharge records to describe the rates of opioid use among HIV-positive pregnant women. Logistic regression was used to quantify the magnitude of the association between exposure status and maternal-fetal outcomes. RESULTS Opioid use was fourfold greater among HIV-positive pregnant women compared with their HIV-negative counterparts (odds ratio 4.0; 95% confidence interval 3.15-5.12). Relatively smaller but significant increases in the early onset of delivery, poor fetal growth, abortive pregnancy, and spontaneous abortion also were observed in association with HIV-positive status and opioid drug use during pregnancy. CONCLUSIONS An increased risk of negative maternal-fetal complications persists among HIV-positive women who use opioids during pregnancy. Focusing on predisposing factors and monitoring opioid dispensing may mitigate overuse or abuse in this vulnerable population.
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Affiliation(s)
- Ngoc H Nguyen
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Erika N Le
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Vanessa O Mbah
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Emily B Welsh
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Rana Daas
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Kiara K Spooner
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Jason L Salemi
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Omonike A Olaleye
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- From Texas Southern University, Houston, Texas and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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Tyndale RF, Sellers EM. Opioids: The Painful Public Health Reality. Clin Pharmacol Ther 2019; 103:924-935. [PMID: 29878319 DOI: 10.1002/cpt.1074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/28/2022]
Abstract
The analgesic, sedative, antidepressant, euphoriant, intoxicating, and addictive properties of opium and its synthetic derivatives are well known and have been known for centuries. Hence, the current major public health problems due to excessive availability should be no surprise. What is unprecedented in the United States, and emerging elsewhere, is the extent of the profound consequences and complexity of addressing this public health crisis.
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Affiliation(s)
- Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Edward M Sellers
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome. Adv Neonatal Care 2019; 19:138-144. [PMID: 30855311 DOI: 10.1097/anc.0000000000000581] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The opioid epidemic in the United States has resulted in an increased number of drug-exposed infants who are at risk for developing neonatal abstinence syndrome (NAS). Historically, these infants have been treated with the introduction and slow weaning of pharmaceuticals. Recently, a new model called Eat, Sleep, Console (ESC) has been developed that focuses on the comfort and care of these infants by maximizing nonpharmacologic methods, increasing family involvement in the treatment of their infant, and prn or "as needed" use of morphine. PURPOSE The purpose of this evidenced-based practice brief was to summarize and critically review emerging research on the ESC method of managing NAS and develop a recommendation for implementing an ESC model. METHODS A literature review was conducted using PubMed, Cochrane, and Google Scholar with a focus on ESC programs developed for treating infants with NAS. FINDING/RESULTS Several studies were found with successful development and implementation of the ESC model. Studies supported the use of ESC to decrease length of stay, exposure to pharmacologic agents, and overall cost of treatment.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=32&autoPlay=true.
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Hall ES, McAllister JM, Wexelblatt SL. Developmental Disorders and Medical Complications Among Infants with Subclinical Intrauterine Opioid Exposures. Popul Health Manag 2019; 22:19-24. [PMID: 29893624 PMCID: PMC6386081 DOI: 10.1089/pop.2018.0016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objective was to compare diagnosis rates representing developmental outcomes and medical complications between infants with intrauterine opioid exposures who did not receive pharmacologic treatment for neonatal abstinence syndrome at the time of birth and infants for whom no exposure to substances of abuse were detected. This retrospective, descriptive study included approximately 95% of Hamilton County, Ohio resident births in 2014 and 2015. Universal maternal drug test results, performed at the time of birth, were documented and linked to electronic health records representing pediatric primary and subspecialty follow-up care as well as urgent care, emergency care, and inpatient services provided by Cincinnati Children's Hospital Medical Center through 2017, when all children were at least 24 months old. Diagnosis rates were compared between drug exposure groups using chi-square tests. Among infants born at >34 weeks gestation and without other complex clinical conditions, infants with subclinical opioid exposures (N = 473) were more likely than infants with no drug exposures (N = 14,933) to be diagnosed with behavioral or emotional disorders (3.0% vs 1.1%, P = 0.0008), developmental delay (15.6% vs 7.6%, P < 0.0001), speech disorder (10.1% vs 6.5%, P = 0.001), or strabismus (3.4% vs 1.0%, P < 0.0001), and more likely to be exposed to the hepatitis C virus (6.8% vs 0.1%, P < 0.0001). Increased diagnosis rates among all opioid exposed infants, regardless of withdrawal severity, may warrant the additional allocation of resources for screening and follow-up. Awareness of the increased risk for certain developmental delays and medical conditions is critical to early intervention and treatment supporting improved outcomes.
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Affiliation(s)
- Eric S. Hall
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer M. McAllister
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott L. Wexelblatt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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