Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004<b>–</b>2014

Winkelman, Tyler N.A.; Villapiano, Nicole; Kozhimannil, Katy B.; Davis, Matthew M.; Patrick, Stephen W.

doi:10.1542/peds.2017-3520

Cited by 319 publications

(269 citation statements)

References 31 publications

Supporting

Mentioning

255

Contrasting

Unclassified

Order By: Relevance

“…The study by Kharasch et al measured the concentrations of R‐ and S‐methadone in healthy subjects after the oral administration of 11 mg (A, B) or the IV administration of 6 mg (C, D) of methadone, respectively. Dale et al 0 measure the concentrations of R,S‐methadone in healthy patients after the oral (E) or IV (F) administration of 10 mg of methadone. Meresaar et al 22 measured the concentration of R,S‐methadone in 8 opioid abusers and provided methadone concentrations in 2 subjects after oral (G) dosing and 3 subjects after the IV (H) administration of 20 mg of methadone.…”

Section: Resultsmentioning

confidence: 99%

“…The opioid epidemic has become a major public health burden in the United States, with the youngest victims being those who are born to opioid‐dependent mothers. According to the Centers for Disease Control and Prevention and other reports, the number of newborns with neonatal abstinence syndrome (NAS) increased by 300% between 1999 and 2013 . NAS describes symptomatic drug withdrawal in newborns.…”

mentioning

confidence: 99%

“…According to the Centers for Disease Control and Prevention and other reports, the number of newborns with neonatal abstinence syndrome (NAS) increased by 300% between 1999 and 2013. [1][2][3] NAS describes symptomatic drug withdrawal in newborns. It is particularly problematic in the setting of chronic intrauterine opioid exposure.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Utilizing Pediatric Physiologically Based Pharmacokinetic Models to Examine Factors That Contribute to Methadone Pharmacokinetic Variability in Neonatal Abstinence Syndrome Patients

McPhail

Emoto

Fukuda

et al. 2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Chronic intrauterine exposure to psychoactive drugs often results in neonatal abstinence syndrome (NAS). NAS is the symptomatic drug withdrawal in newborns that generally occurs after in utero chronic opioid exposure. Methadone is an opioid analgesic commonly prescribed for pharmacologic management of NAS. It exhibits high pharmacokinetic (PK) variability. The current study used physiologically based PK modeling to predict the PK profile of methadone in 20 newborns treated for NAS. The physiologically based PK simulations adequately predicted the PK profile of the clinical data for 45% of the patients. Sensitivity analyses were conducted to explore contributing factors to methadone PK variability. The data suggest that P450 enzymatic activity impacts the clearance of methadone in virtual adults and neonates, while the contribution of cardiac output may be negligible. Understanding maturational and/or pharmacogenetic changes in cytochrome P450 enzymatic activity may further explain the large PK variability of methadone in newborns with NAS and will help individualized treatment.

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Utilizing Pediatric Physiologically Based Pharmacokinetic Models to Examine Factors That Contribute to Methadone Pharmacokinetic Variability in Neonatal Abstinence Syndrome Patients

McPhail

Emoto

Fukuda

et al. 2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Treatment requires additional observation and interventions from skilled healthcare providers. Infants with moderate to severe symptoms typically stay in the hospital neonatal intensive care unit (NICU) an average 16.9 days, with total annual Medicaid costs of over $462 million …”

Section: Introductionmentioning

confidence: 99%

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework

Welborn

2019

Nurs Forum

View full text Add to dashboard Cite

Topic Neonatal nurses who care for infants with symptoms of neonatal abstinence syndrome (NAS) may experience moral distress through conflicting professional ethics. The nurse may find it difficult to simultaneously exemplify beneficence and nonmaleficence. Objective The purpose of this paper is to explore the moral distress of nurses in the context of infants experiencing symptoms of NAS and apply a new conceptual model to this phenomenon. Understanding how nurses navigate moral dilemmas may provide insight into strategies to better support them to address moral conflict. Methods Moral distress was explored in the context of nurses who care for infants with symptoms of NAS. A literature review was completed, followed by the application of the model onto the derived themes. Results The theoretical application resulted in a framework that exemplifies the experience of caring for infants with symptoms of NAS and their families described by many nurses within the literature. If moral distress is not resolved, negative outcomes may be experienced by the nurse, with additional negative outcomes experienced by the family. Conclusion This theoretical model provided insight into the experience of moral distress surrounding nursing care for infants with symptoms of NAS. Additional research is needed to investigate moral residue and moral resilience in this particular caregiving dynamic.

show abstract

“…Infants diagnosed with NAS can experience symptoms with severity ranging from relatively mild (fever or irritability) to severe (seizures and significant weight loss) . NAS has also been associated with prolonged hospitalization, admission to the neonatal intensive care unit, higher health care costs, and an increased risk in infant mortality …”

mentioning

confidence: 99%

Prevalence of Maternal‐Risk Factors Related to Neonatal Abstinence Syndrome in a Commercial Claims Database: 2011‐2015

et al. 2019

View full text Add to dashboard Cite

Background Despite the rising incidence of neonatal abstinence syndrome (NAS), data evaluating trends in maternal risk factors associated with NAS have not been available for recent years, a period characterized by declining opioid prescriptions. The objective of this study was to examine the prevalence of opioid‐ and non–opioid‐related factors associated with NAS, and by mutually exclusive subgroups of deliveries without prescription‐opioid use, with prescription‐opioid use, and with opioid‐use disorder (OUD). Methods A cohort of pregnancies resulting in live births in a commercial claims data base in 2011–2015 was identified. Examples of maternal risk factors of interest included antepartum prescription‐drug use (e.g., opioids, selective serotonin reuptake inhibitors [SSRIs], antipsychotics) and nonprescription‐related factors (e.g., smoking, OUD). Results A total of 659 cases of NAS among 621,940 deliveries was identified. Among NAS deliveries, prescription opioids were the most commonly used drug‐class (39.0%). Adjusted relative risk (RR) for NAS was 5.43 (95% confidence interval [CI] 4.25–6.95), followed by SSRIs (20.9%; RR 3.16, CI 2.43–4.11); OUD was noted in 36.3% of the deliveries (RR 40.74, CI 22.64–73.32). In the subgroup of deliveries without a prescription opioid (33% of overall NAS deliveries), the absolute incidence of NAS was low (0.3 cases/1000 deliveries), and SSRIs were the most commonly used medication class (32.7%; RR 10.21, CI 7.28–14.31). In the subgroup of deliveries with an opioid prescription, the absolute incidence of NAS was 7.7/1000 (29% of all overall NAS deliveries), and 22.7% of these deliveries were exposed to one other psychotropic agent in addition to the opioid, most commonly an SSRI (18.0%). In the subgroup of deliveries with a diagnosis of OUD, the NAS incidence was high (214.3/1000 [36% of all NAS cases]). Conclusion A third of NAS deliveries did not have evidence of prescription opioids. Other psychotropic medications, especially SSRIs, were strong predictors of NAS in this stratum but had no relevance among deliveries with OUD, suggesting varying etiologies and the need for tailored preventive approaches to reduce NAS effectively.

show abstract

Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004–2014

Cited by 319 publications

References 31 publications

Utilizing Pediatric Physiologically Based Pharmacokinetic Models to Examine Factors That Contribute to Methadone Pharmacokinetic Variability in Neonatal Abstinence Syndrome Patients

Utilizing Pediatric Physiologically Based Pharmacokinetic Models to Examine Factors That Contribute to Methadone Pharmacokinetic Variability in Neonatal Abstinence Syndrome Patients

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework

Prevalence of Maternal‐Risk Factors Related to Neonatal Abstinence Syndrome in a Commercial Claims Database: 2011‐2015

Contact Info

Product

Resources

About