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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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2
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Narbey L, Cline A, Demirci JR. Lactation Support for Birthing People With Perinatal Opioid Use Disorder. J Perinat Neonatal Nurs 2024; 38:131-134. [PMID: 38758268 DOI: 10.1097/jpn.0000000000000818] [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: 05/18/2024]
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3
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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4
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Standish KR, Morrison TM, Wanar A, Crowell L, Safon CB, Colson E, Drainoni ML, Colvin BN, Friedman H, Schiff DM, Stulac S, Costello E, Parker M. Breastfeeding Decision-Making Among Mothers with Opioid Use Disorder: A Qualitative Study. Breastfeed Med 2023; 18:347-355. [PMID: 37115582 DOI: 10.1089/bfm.2022.0226] [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: 04/29/2023]
Abstract
Background: Factors that contribute to low initiation and continuation of breastfeeding among mothers with opioid use disorder (OUD) are poorly understood. Objective: To understand barriers and facilitators to breastfeeding initiation and continuation beyond the birth hospitalization for mothers with OUD. Materials and Methods: We conducted 23 in-depth, semistructured interviews with mothers with OUD who cared for their infants at home 1-7 months after birth. Our interview guide was informed by the Theory of Planned Behavior (TPB) framework, which has been used to understand decision-making regarding breastfeeding. An iterative approach was used to develop codes and themes. Results: Among 23 participants, 16 initiated breastfeeding, 10 continued after hospital discharge, and 4 continued beyond 8 weeks. We identified factors influencing breastfeeding decisions in the four TPB domains. Regarding attitudes, feeding intentions were based on beliefs of the healthiness of breastfeeding particularly pertaining to infant withdrawal or exposure to mothers' medications. Regarding social norms, breastfeeding was widely recommended, but mothers had varying levels of trust in medical professional advice. Regarding perceived control, infant withdrawal and maternal pain caused breastfeeding to be difficult, with decisions to continue modulated by level of outside support. Regarding self-efficacy, mothers weighed their own recovery and well-being against the constant demands of breastfeeding, impacting decisions to continue. Conclusion: Mothers with OUD face unique barriers to breastfeeding related to their infants' withdrawal as well as their own health, recovery, and social context. Overcoming these barriers may serve as future intervention targets for breastfeeding promotion among this high-risk population.
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Affiliation(s)
- Katherine R Standish
- Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tierney M Morrison
- Department of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amita Wanar
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisa Crowell
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bryanne N Colvin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Sara Stulac
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Eileen Costello
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Margaret Parker
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Bremer MJ, Knippen KL. Breastfeeding Experiences in Women from Ten States Reporting Opioid Use Before or During Pregnancy: PRAMS, Phase 8. Matern Child Health J 2023; 27:747-756. [PMID: 35947276 DOI: 10.1007/s10995-022-03497-0] [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: 04/15/2021] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Evidence of opioid use at hospital delivery has increased over the past two decades, increasing risk of neonatal withdrawal. Breastfeeding may improve infant outcomes, but little is known about breastfeeding experiences of women who have a history of opioid use prior to or during pregnancy. This study aimed to determine if self-reported opioid use prior to or during pregnancy impacted breastfeeding, specifically attempt to breastfeed, duration of breastfeeding, assessment of prenatal breastfeeding intention, source of breastfeeding information, and early hospital experiences. METHODS Data from ten states (n = 10,550) that evaluated opioid use in the 2016 Pregnancy Risk Assessment Monitoring System survey were included. Weighted univariate and multivariate linear and logistic regression were calculated. The multivariate regression also included adjustment for covariates. RESULTS Among the overall sample, 939 participants reported opioid exposure before or during pregnancy. We found no significant difference in breastfeeding attempt. Breastfeeding for at least 6, 10, or 20 weeks was significantly less likely in participants reporting opioid exposure. Exposure correlated with lower odds of skin-to-skin contact, infant being fed in the first hour, exclusive breastfeeding in the hospital, and feeding on demand. Hospital pacifier use was associated with opioid exposure. CONCLUSION While we found no difference in breastfeeding attempt, we did observe significant differences in breastfeeding duration and early hospital experiences which may represent modifiable gaps in clinical practice. Future work should focus on optimizing early hospital experiences and support when breastfeeding is clinically indicated.
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Affiliation(s)
- Madeleine Jade Bremer
- Food Service Director and Community Nutrition Educator, Camp Beechpoint 3212 125th Ave, Allegan, Michigan, USA
| | - Kerri Lynn Knippen
- Department of Public & Allied Health, Bowling Green State University, 122 Health & Human Services Building, Bowling Green, OH, USA.
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6
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Breastfeeding Recommendations for People Who Use Substances: AWHONN Practice Brief Number 16. J Obstet Gynecol Neonatal Nurs 2023; 52:e1-e4. [PMID: 36328827 DOI: 10.1016/j.jogn.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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7
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Breastfeeding Recommendations for People Who Use Substances: AWHONN Practice Brief Number 16. Nurs Womens Health 2022; 26:e4-e7. [PMID: 36328909 DOI: 10.1016/j.nwh.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Schiff DM, Work EC, Foley B, Applewhite R, Diop H, Goullaud L, Gupta M, Hoeppner BB, Peacock-Chambers E, Vilsaint CL, Bernstein JA, Bryant AS. Perinatal Opioid Use Disorder Research, Race, and Racism: A Scoping Review. Pediatrics 2022; 149:184771. [PMID: 35156121 PMCID: PMC9044279 DOI: 10.1542/peds.2021-052368] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant's first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts,Address correspondence to Davida M. Schiff, MD, MSc, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114. E-mail:
| | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Bridget Foley
- Substance Use Disorder Initiative, Department of Psychiatry
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston Massachusetts
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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9
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Doerzbacher M, Sperlich M, Hequembourg A, Chang YP. Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy. J Obstet Gynecol Neonatal Nurs 2021; 51:29-40. [PMID: 34655544 DOI: 10.1016/j.jogn.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.
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10
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Abstract
Supplemental digital content is available in the text. Background Neonatal abstinence syndrome (NAS) rates have dramatically increased. Breastfeeding is a nonpharmacological intervention that may be beneficial, reducing NAS symptom severity and thus the need for and duration of pharmacological treatment and length of hospital stay. Objectives Conduct meta-analysis to determine whether breastfeeding results in better outcomes for NAS infants. Variables included symptom severity, need for and duration of pharmacological treatment, and length of hospital stay. Methods PubMed, Scopus, Embase, and Cochrane Library were searched from 2000 to 2020, and comparative studies examining breastfeeding for NAS infants were extracted. Randomized trials and cohort studies were included. Data were extracted and evaluated with Review Manager Version 5.3. A random-effects model was used to pool discontinuous outcomes using risk ratio and 95% confidence intervals. Continuous outcomes were evaluated by mean differences and 95% confidence intervals. Results Across 11 studies, 6,375 neonates were included in the meta-analysis. Using a random-effects analysis, breastfeeding reduced initiation of pharmacological treatment, reduced duration of pharmacological treatment, and reduced length of stay. No differences were detected for severity of NAS symptoms. Most studies only reported one to two variables of interest. For most studies, these variables were not the primary study outcomes. All studies were found to be of low risk and good quality based on the Cochrane Risk Assessment Tools. Varying breastfeeding definitions limit generalizability. Discussion Breastfeeding is associated with decreased initiation and duration of pharmacological treatment and length of stay.
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11
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Epstein RL, Moloney C, Garfinkel J, Saia K, Wachman EM, Lodi S, Pelton SI. Enhancing Linkage to Hepatitis C Virus Treatment Following Pregnancy in Women Identified During Perinatal Care. Hepatol Commun 2021; 5:1543-1554. [PMID: 34510828 PMCID: PMC8435278 DOI: 10.1002/hep4.1748] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 02/04/2023] Open
Abstract
Amid the current US opioid crisis, hepatitis C virus (HCV) infection rates continue to rise in young adults, including among pregnant women, yet few studies describe linkage to care and treatment in pregnant or postpartum women with HCV infection. We used electronic health record data to estimate HCV treatment rates for postpartum women before (January 2014-September 2016) and during (October 2016-March 2018) implementation of a maternal-infant HCV linkage program in combination with a multidisciplinary clinic to colocate mother and infant care. Using Poisson regression models, we compared HCV treatment initiation rates, adjusting for demographics, substance use, and treatment. From January 2014 through March 2018, 343 women who were HCV seropositive delivered at our institution. Of these, 95% completed HCV nucleic acid testing and 255 women had chronic HCV infection. Mean age was 30 years, 96% were publicly insured, and 94% had documented substance use. HCV treatment initiation increased from 28/164 (17.1%) women with chronic HCV infection in the preintervention period to 16/66 (24.2%) with the linkage-only intervention and 13/25 (52.0%) with the linkage intervention and colocated care. Adjusted analyses demonstrated that women delivering during the intervention period initiated HCV treatment at 2.40 times (95% confidence interval [CI], 1.10-5.25; linkage only) and 3.36 times (95% CI, 1.57-7.17; linkage and colocated care) the rate of women delivering preintervention. Women on buprenorphine had higher HCV treatment initiation rates compared with those on methadone (rate ratio, 2.10; 95% CI, 1.05-4.21). Conclusion: HCV linkage to care and treatment rates improved in the setting of mother-infant linkage and colocated care interventions. Perinatal care may represent a critical venue to identify, link, and treat women for HCV infection to improve their own health and prevent transmission to subsequent pregnancies.
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Affiliation(s)
- Rachel L Epstein
- Department of MedicineSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA.,Department of PediatricsSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA
| | - Carole Moloney
- Department of PediatricsSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA
| | | | - Kelley Saia
- Department of Obstetrics and GynecologyBoston University School of MedicineBostonMAUSA
| | - Elisha M Wachman
- Department of PediatricsBoston University School of MedicineBostonMAUSA
| | - Sara Lodi
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
| | - Stephen I Pelton
- Department of PediatricsSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA
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12
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Harris M, Joseph K, Hoeppner B, Wachman EM, Gray JR, Saia K, Wakeman S, Bair-Merritt MH, Schiff DM. A Retrospective Cohort Study Examining the Utility of Perinatal Urine Toxicology Testing to Guide Breastfeeding Initiation. J Addict Med 2021; 15:311-317. [PMID: 33060464 PMCID: PMC8044259 DOI: 10.1097/adm.0000000000000761] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE National guidelines advise against breastfeeding for women who use nonprescribed substances in the third trimester. This reduces the number of women who are supported in breastfeeding initiation despite limited evidence on the prognostic value of third trimester substance use. We sought to examine the degree to which prenatal nonprescribed substance use is associated with non-prescribed use postpartum. METHODS Retrospective cohort study of pregnant women with opioid use disorder on methadone or buprenorphine between 2006 and 2015. Nonprescribed use was defined by a positive urine drug testing (UDT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated comparing 3 prenatal periods with postpartum UDT results. Generalized estimating equations were used to examine the extent to which prenatal nonprescribed use was associated with postpartum use. RESULTS Included were 545 deliveries by 503 women. Mean age was 28.3 years, 88% were White/non-Hispanic, 93% had public insurance, and 43% received adequate prenatal care. The predictive value of UDT's 90 to 31 days before delivery, 30 to 0 days before delivery, and at delivery showed low sensitivity (44, 26, 27%, respectively) and positive predictive value (36, 36, 56%, respectively), but higher negative predictive value (80, 85, and 78%, respectively), P-values all <0.05. In the final adjusted model, only nonprescribed use at delivery was significantly associated with postpartum nonprescribed use. CONCLUSIONS Nonprescribed use at delivery was most strongly associated with postpartum use compared with earlier time periods currently prioritized in guidelines. In women with opioid use disorder prenatal UDT results alone are insufficient to guide breastfeeding decisions.
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Affiliation(s)
- Miriam Harris
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston MA, USA
| | - Kathleen Joseph
- Department Emergency Medicine, University of Indiana, Indianapolis, IN, USA
| | - Bettina Hoeppner
- Research Recovery Institute, Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
| | - Elisha M. Wachman
- Division of Neonatology, Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Jessica R. Gray
- Department of Internal Medicine, Massachusetts General Hospital, Boston MA, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA
| | - Sarah Wakeman
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | | | - Davida M. Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
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13
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King RS, Peacock-Chambers E, Wilson D, Shimer J, Foss S, Visintainer P, Singh R. Impact of maternal medication for opioid use disorder on neurodevelopmental outcomes of infants treated for neonatal opioid withdrawal syndrome. J Neonatal Perinatal Med 2021; 14:463-473. [PMID: 33843701 DOI: 10.3233/npm-200615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing rates of maternal opioid use disorder has led to greater number of opioid exposed newborns (OENs). Maternal enrollment in medication for opioid use disorder (MOUD) program improves short term neonatal outcomes. This study aimed at assessing neurobehavioral outcomes for OENs. METHODS Retrospective observational cohort study of OENs between Jul 2006 and Dec 2018. Two study groups were identified as initiation of medication for opioid use disorder (MOUD) prior to diagnoses of pregnancy or after. Primary outcome variables were enrollment in and duration of EI services. Secondary outcome variable was diagnoses of a behavioral and/or developmental disorder (BDD) during the study period. RESULTS Of 242 infants, 113 were enrolled in EI and BDD diagnoses data was available for all infants [age range 6 to 12 years], 82% infants had exposure to maternal MOUD, while 18% were exposed to either maternal prescription non-MOUD opioids or illicit opioids. Maternal MOUD initiation prior to pregnancy was associated with improved short term outcomes for OENs. Almost a third of infants were diagnosed with a BDD with no differences between the two study groups. CONCLUSION Early initiation of maternal MOUD improved short term outcomes and discharge disposition for OENs. Prolonged in-utero exposure to opioids presents a potential for negative impact on neurodevelopmental and behavioral outcomes. These risks must be considered to increase access and adherence to EI services, as well as to focus on non-opioid based maternal MOUD. Longitudinal studies assessing the safety of MOUD on short and long-term child health outcomes are needed.
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Affiliation(s)
- R S King
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.,Department of Pediatrics, Tufts Medical Center, Boston, MA, USA
| | - E Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.,Department of Medicine, Office of Research, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - D Wilson
- Department of Medicine, Office of Research, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - J Shimer
- Massachusetts Department of Public Health, Boston, MA, USA
| | - S Foss
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - P Visintainer
- Department of Medicine, Office of Research, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - R Singh
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.,Department of Pediatrics, Tufts Medical Center, Boston, MA, USA
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14
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Shrestha S, Roberts MH, Maxwell JR, Leeman LM, Bakhireva LN. Post-discharge healthcare utilization in infants with neonatal opioid withdrawal syndrome. Neurotoxicol Teratol 2021; 86:106975. [PMID: 33766722 DOI: 10.1016/j.ntt.2021.106975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
The opioid epidemic in the United States has led to a significant increase in the incidence of neonatal opioid withdrawal syndrome (NOWS); however, the understanding of long-term consequences of NOWS is limited. The objective of this study was to evaluate post-discharge healthcare utilization in infants with NOWS and examine the association between NOWS severity and healthcare utilization. A retrospective cohort design was used to ascertain healthcare utilization in the first year after birth-related discharge using the CERNER Health Facts® database. ICD-9/ICD-10 diagnostic codes were used to identify live births and to classify infants into two study groups: NOWS and uncomplicated births (a 25% random sample). Evaluated outcomes included rehospitalization, emergency department (ED) visits within 30-days and one-year after discharge, and a composite one-year utilization event (either hospitalization or emergency department visit during that year). NOWS severity was operationalized as pharmacologic treatment, length of hospitalization, and medical conditions often associated with NOWS. In 3,526 infants with NOWS (restricted to gestational age ≥ 33 weeks), NOWS severity was associated with an increase in composite one-year utilization (OR: 1.1; 95% CI: 1.04-1.2) after adjusting for prematurity, sepsis, jaundice, use of antibiotics, infant sex, insurance status, race, hospital bed size, year of birth, and census division. In a subset of full-term infants (3008 with NOWS and 88,452 uncomplicated births), having a NOWS diagnosis was associated with higher odds of a 30-day (OR: 1.6; 95% CI: 1.03-2.4) and one-year rehospitalization (OR: 1.6; 95% CI: 1.1-2.4) after adjusting for infant sex, race, type of medical insurance, hospital location, census division, year of primary encounter, hospital bed size, and medical conditions. This study found higher healthcare utilization during the first year of life in infants diagnosed with NOWS, especially those with severe NOWS. Findings suggest a need for closer post-discharge follow-up and management of infants with NOWS.
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Affiliation(s)
- Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA (Current Affiliation), United States of America; Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America.
| | - Melissa H Roberts
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America
| | - Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States of America
| | - Lawrence M Leeman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States of America
| | - Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America; Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States of America; Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
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Cook KJ, Larson KL. Breastfeeding Decision-Making in an Addiction Trajectory: An Exploratory Grounded Theory Study. Res Theory Nurs Pract 2020; 34:371-388. [PMID: 33199409 DOI: 10.1891/rtnp-d-20-00004] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Globally, five million women are affected by opioid use disorder (OUD). Women with OUD are less likely to breastfeed than the general population, increasing risk of neonatal withdrawal. Theoretical frameworks related to breastfeeding did not address women with OUD. The purpose of this study was to develop a conceptual model to better understand breastfeeding disparities among this vulnerable population. METHODS A grounded theory study was conducted from August 2018 to March 2019 to investigate concepts likely to influence breastfeeding decisions in women with OUD. In-depth interviews were conducted in North Carolina with 10 women in recovery who breastfed, and their six identified support persons. Data were analyzed through iterative coding. This article focuses on maternal perspectives of breastfeeding informed by support persons. RESULTS The overarching theme was breastfeeding decision-making in an addiction trajectory. Two antecedent pathways led to the recovery-relapse cycle. This cycle involved seeking, initiating, and maintaining recovery with episodic relapse. Perceived stigma linked the recovery-relapse cycle with breastworks. Breastworks, an emergent concept, was characterized by learning and knowing, good intentions, and health-care provider sensitivity. IMPLICATIONS FOR PRACTICE This grounded theory model may inform clinicians in caring for women with OUD and support breastfeeding and newborn well-being. Strategies to address research and practice may include the development of a mobile application, having women in recovery on the health-care team, and incorporation of breastfeeding guidelines.
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Affiliation(s)
- Kristy J Cook
- East Carolina University College of Nursing, Greenville, NC
| | - Kim L Larson
- East Carolina University College of Nursing, Greenville, NC
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16
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Abstract
PURPOSE OF REVIEW Women with opioid use disorder (OUD) face unique challenges the moment they enter treatment. This narrative review focused on recent literature regarding sex- and gender-based issues that could affect treatment outcomes in women with OUD. RECENT FINDINGS Women respond differently to opioids based on hormonal factors, are more likely to present to treatment with mental health conditions, especially depression, and are more likely to have experienced trauma via intimate partner violence compared with men. Women also face stigma when entering OUD treatment, particularly if they have children. Future research to improve OUD treatment outcomes in women should account for sex as a biological variable and gender as a social construct. Women have a fundamentally different experience than men during the course of OUD and upon treatment entry. Programs that address childcare/family support, mental health, and trauma are warranted for women with OUD.
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Affiliation(s)
- Andrew S Huhn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Kelly E Dunn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
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Devlin LA, Breeze JL, Terrin N, Gomez Pomar E, Bada H, Finnegan LP, O’Grady KE, Jones HE, Lester B, Davis JM. Association of a Simplified Finnegan Neonatal Abstinence Scoring Tool With the Need for Pharmacologic Treatment for Neonatal Abstinence Syndrome. JAMA Netw Open 2020; 3:e202275. [PMID: 32267513 PMCID: PMC7142377 DOI: 10.1001/jamanetworkopen.2020.2275] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Observer-rated scales, such as the Finnegan Neonatal Abstinence Scoring Tool (FNAST), are used to quantify the severity of neonatal abstinence syndrome (NAS) and guide pharmacologic therapy. The FNAST, a comprehensive 21-item assessment tool, was developed for research and subsequently integrated into clinical practice; a simpler tool, designed to account for clinically meaningful outcomes, is urgently needed to standardize assessment. OBJECTIVES To identify FNAST items independently associated with the decision to use pharmacologic therapy and to simplify the FNAST while minimizing loss of information for the treatment decision. DESIGN, SETTING, AND PARTICIPANTS This multisite cohort study included 424 neonates with opioid exposure who had a gestational age of at least 36 weeks with follow-up from birth to hospital discharge in the derivation cohort and 109 neonates with opioid exposure from the Maternal Opioid Treatment: Human Experimental Research Study in the validation cohort. Neonates in the derivation cohort were included in a medical record review at the Universities of Louisville and Kentucky or in a randomized clinical trial and observational study conducted at Tufts University (2014-2018); the Maternal Opioid Treatment: Human Experimental Research was conducted from 2005 to 2008. Data analysis was conducted from May 2017 to August 2019. EXPOSURES Prenatal opioid exposure. MAIN OUTCOMES AND MEASURES All FNAST items were dichotomized as present or not present, and logistic regression was used to identify binary items independently associated with pharmacologic treatment. The final model was validated with an independent cohort of neonates with opioid exposure. RESULTS Among 424 neonates (gestational age, ≥36 weeks; 217 [51%] female infants), convulsions were not observed, and high-pitched cry and hyperactive Moro reflex had extremely different frequencies across cohorts. Therefore, these 3 FNAST items were removed from further analysis. The 2 tremor items were combined, and 8 of the remaining 17 items were independently associated with pharmacologic treatment, with an area under the curve of 0.86 (95% CI, 0.82-0.89) compared with 0.90 (95% CI, 0.87-0.94) for the 21-item FNAST. External validation of the 8 items resulted in an area under the curve of 0.86 (95% CI, 0.79-0.93). Thresholds of 4 and 5 on the simplified scale yielded the closest agreement with FNAST thresholds of 8 and 12 (weighted κ = 0.55; 95% CI, 0.48-0.61). CONCLUSIONS AND RELEVANCE The findings of this study suggest that 8 signs of NAS may be sufficient to assess whether a neonate meets criteria for pharmacologic therapy. A focus on these signs could simplify the FNAST tool and may enhance its clinical utility.
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Affiliation(s)
- Lori A. Devlin
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Janis L. Breeze
- Tufts Clinical and Translational Science Institute, Boston, Massachusetts
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Boston, Massachusetts
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | | | | | | | | | | | - Barry Lester
- Women and Infants Hospital, Providence, Rhode Island
| | - Jonathan M. Davis
- Tufts Clinical and Translational Science Institute, Boston, Massachusetts
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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19
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Yonke N, Jimenez EY, Leeman L, Leyva Y, Ortega A, Bakhireva LN. Breastfeeding Motivators and Barriers in Women Receiving Medications for Opioid Use Disorder. Breastfeed Med 2020; 15:17-23. [PMID: 31692370 DOI: 10.1089/bfm.2019.0122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Women with opioid use disorder (OUD) are encouraged to breastfeed, but have lower breastfeeding rates than the general population. Objective: We examined self-reported barriers and motivators for breastfeeding in women with OUD and the relationship between maternal/postnatal factors and breastfeeding noninitiation/discontinuation. Materials and Methods: A cross-sectional design was used; 40 women with OUD who were eligible to breastfeed were included. Information about breastfeeding initiation, duration, barriers/motivators, demographic characteristics, and self-efficacy was obtained through semi-structured interviews at 4-8 weeks postpartum. Wilcoxon rank sum or Fisher's exact test was used to examine the relationship between maternal/postnatal factors and never-initiated/discontinued breastfeeding. Results: Respondents were 29.3 ± 5.3 years old; most were prescribed buprenorphine (77.5%); and 36.8% of infants were treated for neonatal opioid withdrawal syndrome with methadone or morphine. Most (75.0%) participants initiated breastfeeding; 50.0% continued breastfeeding at 4-8 weeks. The most common motivators included infant health (100%) and bonding (45.0%). On average, women reported discontinuing breastfeeding at 3.3 ± 1.1 weeks postpartum. The most common barriers were concerns regarding transfer of medications or other substances to the infant (50.0%) and concerns about breast milk supply (35.0%). Mean self-efficacy scores were similar among those who continued versus never-initiated/discontinued breastfeeding (33.5 versus 33.0; p = 0.388). Neonatal intensive care unit admission was associated with never-initiated/discontinued breastfeeding (p = 0.047). Conclusion: Women with OUD share many similar motivators and barriers to breastfeeding with the general population. Unique concerns include infant exposure to medications or substances, even in those who are eligible to breastfeed, which should be addressed by targeted education for patients and providers.
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Affiliation(s)
- Nicole Yonke
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Elizabeth Yakes Jimenez
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Alyssa Ortega
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ludmila N Bakhireva
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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20
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Paterno MT, Jablonski L, Klepacki A, Friedmann PD. Evaluation of a Nurse-Led Program for Rural Pregnant Women With Opioid Use Disorder to Improve Maternal–Neonatal Outcomes. J Obstet Gynecol Neonatal Nurs 2019; 48:495-506. [DOI: 10.1016/j.jogn.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/28/2023] Open
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21
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Supporting breastfeeding for women on opioid maintenance therapy: a systematic review. J Perinatol 2019; 39:1159-1164. [PMID: 31263203 DOI: 10.1038/s41372-019-0411-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite evidence to support breastfeeding, rates remain low in women on opioid maintenance therapy (OMT). The goal of this review was to synthesize current knowledge regarding interventions to promote breastfeeding in women on OMT. STUDY DESIGN A systematic search of databases including PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and the Cochrane database of systematic reviews was conducted. Key words included breastfeeding, lactation, opioid use disorder, and opioid maintenance therapy. Risk of bias was assessed by two reviewers. RESULT Four quasi-experimental studies met inclusion criteria. Improved rates of breastfeeding reached statistical significance in all four. Three studies had moderate to serious risk of bias related to confounding variables. Interventions shared common features, including an integrated approach, a well-prepared multidisciplinary team, nonseparation of mother and newborn, and patient centered care. CONCLUSIONS Further research should explore barriers and facilitators to breastfeeding in this vulnerable population.
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22
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Clark RRS. Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice. J Midwifery Womens Health 2019; 64:545-558. [PMID: 31294522 DOI: 10.1111/jmwh.12982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations. METHODS CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy. RESULTS Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. DISCUSSION Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population.
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Affiliation(s)
- Rebecca R S Clark
- Department of Community and Public Health, Johns Hopkins University, Baltimore, Maryland
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23
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Favara MT, Carola D, Jensen E, Cook A, Genen L, Dysart K, Greenspan JS, Aghai ZH. Maternal breast milk feeding and length of treatment in infants with neonatal abstinence syndrome. J Perinatol 2019; 39:876-882. [PMID: 30988400 DOI: 10.1038/s41372-019-0374-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to assess whether infants with neonatal abstinence syndrome (NAS), who receive maternal breast milk (BM), have shorter pharmacological treatment durations and lengths of stay compared with formula-fed infants. STUDY DESIGN Retrospective data analysis from Optum Neonatal Database for infants born between 1 January 2010 and 21 November 2016, who received treatment for NAS. Clinical characteristics and outcomes were compared between infants who received any amount of BM and those exclusively formula-fed. RESULT Infants (1738) were analyzed. Median length of pharmacological treatment was significantly lower in infants who received any BM (14 days) compared with "no BM" group (17 days, p = 0.04). Similarly, median length of hospitalization was significantly reduced in "any BM" group (19 days vs. 20 days), which remained significant after adjustment for confounders (p = 0.01). There was no difference in hospital re-admission rates. CONCLUSION Feeding any BM to infants with NAS was associated with both decreased lengths of pharmacological treatment and hospital stay compared with exclusively formula-fed infants.
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Affiliation(s)
- Michael T Favara
- Department of Neonatology, Thomas Jefferson University Hospital/Nemours, Philadelphia, PA, USA
| | - David Carola
- Department of Neonatology, Thomas Jefferson University Hospital/Nemours, Philadelphia, PA, USA
| | - Erik Jensen
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Kevin Dysart
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jay S Greenspan
- Department of Neonatology, Thomas Jefferson University Hospital/Nemours, Philadelphia, PA, USA
| | - Zubair H Aghai
- Department of Neonatology, Thomas Jefferson University Hospital/Nemours, Philadelphia, PA, USA.
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Cook KJ, Larson KL. Breastworks: Breastfeeding practices among women with substance use disorder. Appl Nurs Res 2019; 47:41-45. [PMID: 31113546 DOI: 10.1016/j.apnr.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Kristy J Cook
- East Carolina University College of Nursing, 4305 Health Sciences Building, Mailstop 162, Greenville, NC 27834, United States.
| | - Kim L Larson
- East Carolina University College of Nursing, 4305 Health Sciences Building, Mailstop 162, Greenville, NC 27834, United States.
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Abstract
Tens of thousands of infants are impacted yearly by prenatal opioid exposure. The term neonatal opioid withdrawal syndrome (NOWS) is now replacing the more familiar term neonatal abstinence syndrome (NAS). Ongoing debate continues related to standard regimens for treatment of this oftentimes perplexing condition. Historically, treatment has focused on pharmacologic interventions. However, there is limited research that points to nonpharmacologic methods of treatment as viable options, whether alone or in addition to pharmacologic interventions. This article, utilizing a review of pertinent literature, outlines the physical aspects of NOWS, including its pathophysiology and the resulting physical clinical signs. In addition, we present an overview of how age-appropriate, nonpharmacologic interventions, centered on developmental care, may be a valuable approach to organize and prioritize routine care for these infants, their families, and the health care team facing the challenges of NOWS. Finally, the need for further research to better define evidence-based standards of care for these infants and their families is discussed.
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Bogen DL, Whalen BL. Breastmilk feeding for mothers and infants with opioid exposure: What is best? Semin Fetal Neonatal Med 2019; 24:95-104. [PMID: 30922811 DOI: 10.1016/j.siny.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
With rare exception, breastfeeding is the optimal way to feed infants, and has special benefits for women and infants with perinatal opioid exposure. Infants breastfed and/or fed their mother's own breastmilk experience less severe opioid withdrawal symptoms, have shorter hospital stays, and are less likely to be treated with medication for withdrawal. The specific impact of mothers' milk feeding on opioid withdrawal may be related to the act of breastfeeding and associated skin-to-skin contact, qualities of breastmilk, healthier microbiome, small amounts of opioid drug in breastmilk, or a combination of these. Women with opioid use disorder face significant breastfeeding obstacles, including psychosocial, behavioral, concomitant medications, and tobacco use and thus may require high levels of support to achieve their breastfeeding goals. They often don't receive information to make informed infant feeding decisions. Hospital practices such as prenatal education, rooming-in and having a policy that minimizes barriers to breastfeeding are associated with increased breastfeeding rates.
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Affiliation(s)
- Debra L Bogen
- University of Pittsburgh School of Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 3414 Fifth Ave, Pittsburgh, PA, 15213, USA.
| | - Bonny L Whalen
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, DHMC Pediatrics, One Medical Center Drive, Lebanon, NH, 03756, USA.
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Promoting resilience in vulnerable populations: focus on opioid-exposed children, siblings of children with special healthcare needs and support for children through school-based interventions. Curr Opin Pediatr 2019; 31:157-165. [PMID: 30531404 DOI: 10.1097/mop.0000000000000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Resilience is an important factor in withstanding the health consequences of childhood adversity. This article discusses recent literature related to promoting resilience in opioid-exposed children and siblings of children with special healthcare needs. It also addresses ways that school systems can foster childhood resilience. RECENT FINDINGS Rising rates of opioid-exposed newborns have necessitated the development of multiple strategies to address the medical and social needs of this vulnerable pediatric population. Siblings of children with special healthcare needs are a growing but sometimes overlooked group who have unique challenges that can be supported by healthcare providers. School programs that reward positive behavior and encourage self-regulation through activities like physical activity and mindfulness can foster an environment for improved youth resiliency. SUMMARY New research has led to the development of resources that help pediatric providers assess the needs of their vulnerable patient populations and foster resilience through attention to these patients' medical, emotional and social needs. Patients benefit from national policy efforts and local school programs that each promote resilience.
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McGlothen KS, Cleveland LM. The Right to Mother's Milk: A Call for Social Justice That Encourages Breastfeeding for Women Receiving Medication-Assisted Treatment for Opioid Use Disorder. J Hum Lact 2018; 34:799-803. [PMID: 30040908 DOI: 10.1177/0890334418789401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kelly S McGlothen
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lisa M Cleveland
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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