Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010–2017

Hirai, Ashley H.; Ko, Jean Y.; Owens, Pamela L; Stocks, Carol; Patrick, Stephen W.

doi:10.1097/01.ogx.0000754372.26284.fb

Cited by 32 publications

(59 citation statements)

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“…The incidence of NAS in WA was comparable to other countries including the United Kingdom and Canada, 18 but was substantially lower than recent reports from the United States 19,20 . Unlike countries such as the United States and Canada, increases in NAS were not observed 10–12 . The incidence of NAS was higher than measured in a previous WA study (2.7 per 1000 births), 18 but were similar to rates in New South Wales (Australia) between 2006 and 2011 (3.4 per 1000 births) 21 .…”

Section: Discussionsupporting

confidence: 49%

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Contribution of pharmaceutical drugs of dependence to the incidence of neonatal abstinence syndrome in Western Australia between 2003 and 2018

2022

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Study objective The aim of this study was to examine the incidence of neonatal abstinence syndrome (NAS) in Western Australia (WA) and estimate the contribution of pharmaceutical drugs of dependence (PDD) to NAS. Design A population‐based birth cohort study. Data source Neonates were identified through the Midwives Notification Scheme. Linked medication dispensing and hospital records were used to identify exposure to PDD and NAS diagnosis. Patients All live born neonates born in WA between 2003 and 2018. Measurements The incidence of NAS and percentage of NAS diagnoses associated with exposure to PDD. Main results During the study period, the incidence of NAS did not significantly change (annual percentage change (APC): 0.6, 95%CI: −1.3, 2.6), with 3.8 neonates per 1,000 live births diagnosed with NAS. PDD were dispensed to 41.4% of mothers of neonates with NAS, with PDD used to treat opioid use disorders the most commonly prescribed (35.2% of neonates with NAS), while opioid PDD used in the treatment of pain contributed to 5.2% of NAS cases. Non‐opioid PDD contributed to 1.7% of cases of NAS. The incidence of NAS associated with the use of opioids used to treat opioid use disorders (OUD) decreased over the study period (APC: −6.5, 95%CI: −9.5, −3.4), while NAS associated with opioids used to treat pain remained stable (APC: −2.7, 95%CI: −7.1, 1.9). Conclusion The incidence of neonatal abstinence syndrome in WA remained stable from 2003 to 2018. Medications used to treat opioid use disorders were a substantial driver of NAS, although NAS associated with these medications has declined over time.

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Section: Discussionsupporting

confidence: 49%

“…In recent years, a number of countries have observed substantial increases in the diagnosis of NAS 10–12 . In the United States between 2010 and 2017 the rate of NAS per 1000 birth increased from 4.0 to 7.3 12 . Similarly, in Canada the rate rose from 1.8 to 5.4 per 1000 live births between 2003 and 2014 10 .…”

Section: Introductionmentioning

confidence: 99%

Contribution of pharmaceutical drugs of dependence to the incidence of neonatal abstinence syndrome in Western Australia between 2003 and 2018

2022

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Section: Introductionmentioning

confidence: 99%

“…In the last two decades, the rates of opioid use disorder (OUD) among pregnant women rose dramatically 1 . As a result, neonatal opioid withdrawal syndrome has increased over sevenfold 1,2 . Given that medications for the treatment of OUD, such as methadone, represent a large proportion of these prenatal opioid exposure (POE) cases, 3 our laboratory developed a translationally relevant model of prenatal methadone exposure (PME) to address the effects of methadone exposure on development without the influence of other environmental factors that may confound clinical studies such as reduced prenatal care, concurrent drug use and comorbid health conditions 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Prenatal opioid exposure reprograms the behavioural response to future alcohol reward

et al. 2022

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As the opioid crisis has continued to grow, so has the number of infants exposed to opioids during the prenatal period. A growing concern is that prenatal exposure to opioids may induce persistent neurological changes that increase the propensity for future addictions. Although alcohol represents the most likely addictive substance that the growing population of prenatal opioid exposed will encounter as they mature, no studies to date have examined the effect of prenatal opioid exposure on future sensitivity to alcohol reward. Using a recently developed mouse model of prenatal methadone exposure (PME), we investigated the rewarding properties of alcohol and alcohol consumption in male and female adolescent PME and prenatal saline exposed (PSE) control animals. Conditioned place preference to alcohol was disrupted in PME offspring in a sex-dependent manner with PME males exhibiting resistance to the rewarding properties of alcohol. Repeated injections of alcohol revealed enhanced sensitivity to the locomotor-stimulating effects of alcohol specific to PME females. PME males consumed significantly more alcohol over 4 weeks of alcohol access relative to PSE males and exhibited increased resistance to quinineadulterated alcohol. Further, a novel machine learning model was developed to employ measured differences in alcohol consumption and drinking microstructure to reliably predict prenatal exposure. These findings indicate that PME alters the sensitivity to alcohol reward in adolescent mice in a sex-specific manner and suggests prenatal opioid exposure may induce persistent effects on reward neurocircuitry that can reprogram offspring behavioural response to alcohol later in life.

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“…[8][9][10][11] Like many states, Maryland witnessed a substantial increase in the rate of NAS to 13.4 per 1,000 live births by 2014. 3 We report the impact of a statewide Maryland Collaborative that harmonized approaches to diagnosis, assessment, and management across 31 of 32 birthing hospitals. This effort was well underway at the time of initial publication of the Eat-Sleep-Console (ESC) approach of resource-intensive non-pharmacologic care.…”

Section: Introductionmentioning

confidence: 99%

Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in Maryland

et al. 2022

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Objectives: A statewide Maryland Perinatal Neonatal Quality Collaborative, facilitated by the Maryland Patient Safety Center (MPSC), identified the three specific, measurable, attainable, relevant, and time-limited (SMART) aims to improve outcomes of NAS care: (1) to reduce hospital length of stay (LOS), (2) to reduce interhospital transfers, and (3) to reduce 30-day readmission rates of infants with neonatal abstinence syndrome (NAS). Study Design: The Maryland collaborative developed a bundle of best practices for care of infants with NAS. MPSC partnered with Vermont Oxford Network (VON) to utilize the VON NAS toolkit and provide its standardized NAS educational curriculum to address the three objectives for participating birthing hospitals. Efforts began in quarter 4 (Q4) 2016 and continued for two years. Thirty-one of Maryland’s 32 delivery hospitals (97%) participated in the two-year collaborative. Additionally, one specialty pediatric hospital with a NAS unit participated in the group learnings. Participating facilities implemented components of the MPSC NAS bundle and provided their staff caring for infants with NAS and their mothers access to the VON standardized educational curriculum. MPSC partnered with VON to conduct two audits of implementation of policies and procedures in Q1 2016 and Q3 2018. The Maryland Department of Health supplied quarterly aggregate hospital information on LOS, interhospital transfers, and 30-day readmissions of infants with a discharge diagnosis of ICD-10 P96.1. Results: Among term infants with NAS with total hospital stay greater than 5 days, we observed a non-significant reduction in both mean and median LOS of 1.5 days. In this same group, the rate of interhospital transfers fell significantly from 20.1% in 2016 to 13.8% in 2017 and to 11.0% in 2018. Conclusion: The best practice bundle created by the Maryland collaborative was associated with a reduction in the percentage of infants with NAS who required interhospital transfer, thereby reducing family disruption.

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Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010–2017

Cited by 32 publications

References 0 publications

Contribution of pharmaceutical drugs of dependence to the incidence of neonatal abstinence syndrome in Western Australia between 2003 and 2018

Contribution of pharmaceutical drugs of dependence to the incidence of neonatal abstinence syndrome in Western Australia between 2003 and 2018

Prenatal opioid exposure reprograms the behavioural response to future alcohol reward

Improving Outcomes through a Neonatal Abstinence Syndrome Collaborative in Maryland

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