PDF herunterladen
Am J Perinatol 2022; 39(04): 387-393
DOI: 10.1055/s-0040-1716490
Original Article

Hospital Outcomes of Infants with Neonatal Opioid Withdrawal Syndrome at a Tertiary Care Hospital with High Rates of Concurrent Nonopioid (Polysubstance) Exposure

Erin Morris
1   Department of Pediatrics, Residency & Fellowship Program, Salt Lake City, Utah
,
Tyler Bardsley
2   Division of Epidemiology, University of Utah Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, Utah
,
Krista Schulte
3   College of Nursing, University of Utah, Salt Lake City, Utah
,
Jeanette Seidel
3   College of Nursing, University of Utah, Salt Lake City, Utah
,
Julie H. Shakib
4   Division of General Pediatrics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
,
Karen F. Buchi
4   Division of General Pediatrics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
,
Camille M. Fung 
5   Division of Pediatric Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
› Institutsangaben Funding This investigation was supported by the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067–05 (formerly 8UL1TR000105 and UL1RR025764).
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective Neonatal opioid withdrawal syndrome (NOWS) describes infants' withdrawal signs and symptoms after birth due to an interruption of prenatal opioid exposure. Many infants with NOWS are also exposed to nonopioids, however. This study was to determine hospital outcomes of infants exposed to opioids alone or coexposed with nonopioid substances (polysubstance).

Study Design We reviewed infants of ≥34 weeks of gestation with prenatal opioid exposure from April 2015 to May 2018. We compared the median lengths of stay (LOS) and treatment (LOT) and the percentages of infants requiring pharmacologic and adjunctive treatment in infants exposed to opioids alone or polysubstance. We used Wilcoxon's test for continuous outcomes or Chi-squared test for categorical outcomes to determine statistical significance. We used multivariable regression model to calculate each drug category's estimates of adjusted mean ratios for LOS and LOT plus estimates of adjusted odds ratios for pharmacologic/adjunctive treatments.

Results Of the 175 infants, 33 (19%) infants had opioid exposure alone. Opioid exposure included short- and/or long-acting opioids. A total of 142 (81%) had polysubstance exposure with 47% of mothers using nicotine products. We saw similar hospital outcomes between infants exposed to opioids alone or polysubstance; however, a higher percentage of infants with both short- and long-acting opioid exposure required pharmacologic treatment compared with either opioid alone. Focusing on individual drug categories, we detected differential hospital outcomes in which short-acting opioids decreased LOT, whereas long-acting opioids increased LOS, LOT, and need for pharmacologic and adjunctive treatment. Coexposure of opioids with stimulants decreased LOT and reduced need for adjunctive treatment. Coexposures with antidepressants increased LOT, while with antiepilepetics increased LOS.

Conclusion Because infants with NOWS often have coexposures to other nonopioid substances, appreciating the associated risks of individual or combination of drugs in modulating hospital outcomes may help counsel families on their infants' expected hospital course.

Key Points

  • Hospital outcomes were similar between infants exposed to opioids alone or polysubstance including opioids.

  • Infants with short- and long-acting opioids required pharmacologic treatment more often than either opioid alone.

  • Differential hospital outcomes exist for various co-exposures of opioids with nonopioids.

Keywords

neonatal opioid withdrawal syndrome - length of stay - length of treatment - polysubstance exposure


Publikationsverlauf

Eingereicht: 19. April 2020

Angenommen: 30. Juli 2020

Artikel online veröffentlicht:
06. September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Haight S, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitalization - United States, 1999–2014. Centers Dis Control Prevent MMWR 2018; 67 (31) 845-849
    PubMedGoogle Scholar
  • 2 Hudak ML, Tan RC. Committee on Drugs, Committee on Fetus and Newborn, American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
    CrossrefPubMedGoogle Scholar
  • 3 Sanlorenzo LA, Stark AR, Patrick SW. Neonatal abstinence syndrome: an update. Curr Opin Pediatr 2018; 30 (02) 182-186
    CrossrefPubMedGoogle Scholar
  • 4 Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014; 134 (02) e547-e561
    CrossrefPubMedGoogle Scholar
  • 5 Forray A, Merry B, Lin H, Ruger JP, Yonkers KA. Perinatal substance use: a prospective evaluation of abstinence and relapse. Drug Alcohol Depend 2015; 150: 147-155
    CrossrefPubMedGoogle Scholar
  • 6 Zahorodny W, Rom C, Whitney W. et al. The neonatal withdrawal inventory: a simplified score of newborn withdrawal. J Dev Behav Pediatr 1998; 19 (02) 89-93
    CrossrefPubMedGoogle Scholar
  • 7 Bose J, Hedden SL, Lipari RN, Park-Lee E. Key substance use and mental health indicators in the United States: results from the 2017 National Survey on Drug Use and Health. Accessed August 19, 2020 at: https://store.samhsa.gov/sites/default/files/d7/priv/sma18-5068.pdf
    PubMedGoogle Scholar
  • 8 Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep 2018; 67 (5152): 1419-1427
    CrossrefPubMedGoogle Scholar
  • 9 Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol 2014; 123 (05) 997-1002
    CrossrefPubMedGoogle Scholar
  • 10 Smid MC, Stone NM, Baksh L. et al. Pregnancy-associated death in Utah: contribution of drug-induced deaths. Obstet Gynecol 2019; 133 (06) 1131-1140
    CrossrefPubMedGoogle Scholar
  • 11 Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015; 35 (08) 650-655
    CrossrefPubMedGoogle Scholar
  • 12 Patrick SW, Kaplan HC, Passarella M, Davis MM, Lorch SA. Variation in treatment of neonatal abstinence syndrome in US children's hospitals, 2004-2011. J Perinatol 2014; 34 (11) 867-872
    CrossrefPubMedGoogle Scholar
  • 13 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
    CrossrefPubMedGoogle Scholar
  • 14 Tolia VN, Patrick SW, Bennett MM. et al. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. N Engl J Med 2015; 372 (22) 2118-2126
    CrossrefPubMedGoogle Scholar
  • 15 Hall ES, Wexelblatt SL, Crowley M. et al; OCHNAS Consortium. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics 2014; 134 (02) e527-e534
    CrossrefPubMedGoogle Scholar
  • 16 Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of neonatal abstinence syndrome - 28 states, 1999-2013. MMWR Morb Mortal Wkly Rep 2016; 65 (31) 799-802
    CrossrefPubMedGoogle Scholar
  • 17 Wachman EM, Grossman M, Schiff DM. et al. Quality improvement initiative to improve inpatient outcomes for neonatal abstinence syndrome. J Perinatol 2018; 38 (08) 1114-1122
    CrossrefPubMedGoogle Scholar
  • 18 Wachman EM, Warden AH, Thomas Z. et al. Impact of psychiatric medication co-exposure on neonatal abstinence syndrome severity. Drug Alcohol Depend 2018; 192: 45-50
    CrossrefPubMedGoogle Scholar
  • 19 Huybrechts KF, Bateman BT, Desai RJ. et al. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. BMJ 2017; 358: j3326
    CrossrefPubMedGoogle Scholar
  • 20 Sanlorenzo LA, Cooper WO, Dudley JA, Stratton S, Maalouf FI, Patrick SW. Increased severity of neonatal abstinence syndrome associated with concomitant antenatal opioid and benzodiazepine exposure. Hosp Pediatr 2019; 9 (08) 569-575
    CrossrefPubMedGoogle Scholar