A Longitudinal Healthcare Use Profile of Children with a History of Neonatal Abstinence Syndrome

Liu, Guodong; Kong, Lan; Leslie, Douglas L.; Corr, Tammy E.

doi:10.1016/j.jpeds.2018.08.032

Cited by 26 publications

(24 citation statements)

References 33 publications

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“…3,19 One recent retrospective study using a national insurance database revealed higher rates of all health care use (admissions, ED visits, and outpatient visits) in this population, with an overall lower proportion of care attributed to WCC visits. 51 Our findings are also consistent with previous research revealing socioeconomic disparities in WCC adherence. 27 Some of the key drivers hypothesized to impact WCC adherence include transportation issues, time constraints, family crisis events, and low perceived value of primary care.…”

Section: Gaps In Wccsupporting

confidence: 92%

Well-Child Care Adherence After Intrauterine Opioid Exposure

Goyal¹,

Rohde

Short

et al. 2020

Pediatrics

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BACKGROUND AND OBJECTIVES: For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population. METHODS:In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15-and 18-month visits. Gaps in WCC, defined as $2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status.RESULTS: Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed (P , .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [P , .001] and 0.74 [P , .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P , .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening. CONCLUSIONS:Children ,2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population.

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Section: Gaps In Wccsupporting

confidence: 92%

Well-Child Care Adherence After Intrauterine Opioid Exposure

Goyal¹,

Rohde

Short

et al. 2020

Pediatrics

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“…13,18 The few longitudinal studies that have been published indicate that infants diagnosed with NOW have higher rates of healthcare utilization through 8 years of age and progressively worsening academic performance through high school. 9,24 While our study has limitations, probabilistic and deterministic sensitivity analyses demonstrated that our model remained robust even after inputs were varied across the minimum and maximum extremes within a clinically plausible range.…”

Section: Commentmentioning

confidence: 83%

A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid Withdrawal

et al. 2019

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Objective Our cost-effectiveness analysis investigated rooming-in versus not rooming-in to determine optimal management of neonates with neonatal opioid withdrawal (NOW). Study Design A decision-analytic model was constructed using TreeAge to compare rooming-in versus not rooming-in in a theoretical cohort of 23,200 newborns, the estimated annual number affected by NOW in the United States. Additional considerations included the effect of breast milk versus formula milk in evaluating the need for pharmacotherapy. Primary outcomes were needed for pharmacotherapy and neurodevelopment. We assumed a societal perspective in evaluating costs and maternal-neonatal quality-adjusted life years (QALYs) using a willingness-to-pay threshold of $100,000/QALY. Model inputs were derived from literature and varied in sensitivity analyses. Results Rooming-in resulted in fewer neonates requiring pharmacotherapy when compared with not rooming-in. The rooming-in group had more neonates with intact/mild neurodevelopmental impairment and fewer cases of moderate to severe impairment. Rooming-in resulted in cost savings of $509,652,728 and 12,333 additional QALYs per annual cohort. When the risk ratio of need for pharmacotherapy in rooming-in was varied across a clinically plausible range, rooming-in remained the cost-effective strategy. Conclusion Maternal rooming-in with newborns affected by NOW leads to reduced costs and increased effectiveness. Management strategies should optimize nonpharmacological interventions as first-line treatment.

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“…4 Current research suggests increased risk for morbidity, emergency department utilization, and rehospitalization after discharge in this population as well as difficulty in accessing and engaging with pediatric preventative care. 45,46 A clear plan should be established upon discharge to ensure optimal newborn care and follow-up. A complete record of the newborn's hospital stay, including maternal toxicology screenings and summary of any social work documentation, should be communicated to the primary care provider upon discharge.…”

Section: Discharge Planningmentioning

confidence: 99%

“…Regardless of whether or not NAS is treated pharmacologically, newborns with opioid exposure may experience residual symptoms of withdrawal that persist for months 4 . Current research suggests increased risk for morbidity, emergency department utilization, and rehospitalization after discharge in this population as well as difficulty in accessing and engaging with pediatric preventative care 45, 46 …”

Section: Discharge Planningmentioning

confidence: 99%

Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

Goyal

McAllister

2020

Journal of Hospital Medicine

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In the past two decades, the incidence of neonatal abstinence syndrome (NAS) has risen fivefold, mirroring the rise of opioid use disorder (OUD) among pregnant women. The resulting increases in length of stay and neonatal intensive care utilization are associated with higher hospital costs, particularly among Medicaid-financed deliveries. Pregnant women with OUD require comprehensive medical and psychosocial evaluation and management; this combined with medication-assisted treatment is critical to optimize maternal and newborn outcomes. Multidisciplinary collaboration and standardized approaches to screening for intrauterine opioid exposure, evaluation and treatment of NAS, and discharge planning are important for clinical outcomes and may improve maternal experience of care.

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A Longitudinal Healthcare Use Profile of Children with a History of Neonatal Abstinence Syndrome

Cited by 26 publications

References 33 publications

Well-Child Care Adherence After Intrauterine Opioid Exposure

Well-Child Care Adherence After Intrauterine Opioid Exposure

A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid Withdrawal

Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

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