BACKGROUND AND OBJECTIVES:
Variation in pediatric medical care is common and contributes to differences in patient outcomes. Site-to-site variation in the characteristics and care of infants with neonatal opioid withdrawal syndrome (NOWS) has yet to be quantified. Our objective was to describe site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS.
METHODS:
Cross-sectional study of 1377 infants born between July 1, 2016, and June 30, 2017, who were ≥36 weeks’ gestation, with NOWS (evidence of opioid exposure and NOWS scoring within the first 120 hours of life) born at or transferred to 1 of 30 participating hospitals nationwide. Site-to-site variation for each parameter within the 3 domains was measured as the range of individual site-level means, medians, or proportions.
RESULTS:
Sites varied widely in the proportion of infants whose mothers received adequate prenatal care (31.3%–100%), medication-assisted treatment (5.9%–100%), and prenatal counseling (1.9%–75.5%). Sites varied in the proportion of infants with toxicology screening (50%–100%) and proportion of infants receiving pharmacologic therapy (6.7%–100%), secondary medications (1.1%–69.2%), and nonpharmacologic interventions including fortified feeds (2.9%–90%) and maternal breast milk (22.2%–83.3%). The mean length of stay varied across sites (2–28.8 days), as did the proportion of infants discharged with their parents (33.3%–91.1%).
CONCLUSIONS:
Considerable site-to-site variation exists in all 3 domains. The magnitude of the observed variation makes it unlikely that all infants are receiving efficient and effective care for NOWS. This variation should be considered in future clinical trial development, practice implementation, and policy development.
Objective
To evaluate whether the association between maternal
periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and
increased risk of congenital heart defects in offspring is modified by maternal
or infant genetic variants in folate, homocysteine, or transsulfuration
pathways.
Design
Population based study. DNA from mothers, fathers, and
infants was genotyped with an Illumina GoldenGate custom single nucleotide
polymorphism panel. A hybrid design based on a log linear model was used to
calculate relative risks and Bayesian false discovery probabilities (BFDP) to
identify polymorphisms associated with congenital heart defects modified by SSRI
use.
Data sources
Data from the US National Birth Defects Prevention
Study on 1180 liveborn infants with congenital heart defects and 1644 controls,
born 1997-2008.
Main outcome measures
Cases included infants with selected
congenital heart defects and control infants had no major defects. SSRI use was
obtained from telephone interviews with mothers.
Results
For women who reported taking SSRIs periconceptionally,
maternal SHMT1 (rs9909104) GG and AG
genotypes were associated with a 5.9
and 2.4 increased risk of select congenital heart defects in offspring,
respectively, versus the AA genotype (BFDP=0.69). Compared with the AA genotype,
BHMT (rs492842 and rs542852) GG and AG genotypes were associated with twice the
risk
of congenital heart defects (BFDP=0.74 and 0.79, respectively). MGST1
(rs2075237) CC and AC
genotypes were associated with an increased risk
compared with the GG genotype (8.0 and 2.8, respectively; BFDP=0.79). Single
nucleotide polymorphism in infant genes in the folate (MTHFS rs12438477),
homocysteine (TRDMT1 rs6602178 and GNMT rs11752813) and transsulfuration (GSTP1
rs7941395 and MGST1 rs7294985) pathways were also associated with an increased
risk of congenital heart defects.
Conclusions
Common maternal or infant genetic variants in folate,
homocysteine, or transsulfuration pathways are associated with an increased risk
of certain congenital heart defects among children of women taking SSRIs during
cardiogenesis.
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