Browsing by Subject "Neonatal abstinence syndrome (NAS)"

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    83569 Receipt of Pharmacologic Weaning Therapy and Developmental Delay
    (Cambridge University Press, 2021) Campbell, Angela G.; Zhang, Pengyue; Gharbi, Sami; Wiehe, Sarah; Pediatrics, School of Medicine
    ABSTRACT IMPACT: This study evaluates the long term effects of pharmacologic weaning therapy for opiate exposed infants. OBJECTIVES/GOALS: Infants born to chronic opioid users often suffer from neonatal abstinence syndrome (NAS), a condition characterized by tremors, diarrhea, hyperirritability and an inconsolable high-pitched cry. Symptoms are treated with pharmacologic weaning therapy, but long-term effects of this treatment have not been established. METHODS/STUDY POPULATION: A sample of infants born between 2011-2017 was obtained from a large metropolitan hospital system. All infants who were exposed to opioids and received a Finnegan score were included in the sample (N=1,807). The analysis utilizes three dependent variables to measure developmental delay: motor delay, language delay or any delay, which includes general/non-specific delay in addition to motor and language delay. The treatment is defined as receipt of pharmacologic therapy with methadone or morphine. Maximum Finnegan score was also included as a continuous measure of the extent of the infant’s withdrawal symptoms. Linear models were utilized to determine a relationship between pharmacologic therapy and developmental delay with Maximum Finnegan score as an interaction term. RESULTS/ANTICIPATED RESULTS: In the linear models examining the main effects of weaning therapy on developmental delay, there was no relationship between pharmacologic therapy and motor delay (p=.260), language delay (p=.542) or any developmental delay (p=.176). When maximum Finnegan score was entered into the model as an interaction term the relationships were not significant. DISCUSSION/SIGNIFICANCE OF FINDINGS: These results suggest that while pharmacologic weaning is an appropriate treatment for withdrawal symptoms in infants, it is not a deterrent against developmental delays associated with NAS. This provides support suggest an increased focus on non-pharmacologic interventions such as breastfeeding as the first line of treatment for NAS infants.
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    Pharmacologic Therapy Among Opioid-Exposed Infants: Disparities By Race
    (Wiley, 2020-08) Campbell, A.; Scott, E.; Gharbi, S.; Wiehe, Sarah; Medicine, School of Medicine
    Research Objective: The incidence of neonatal abstinence syndrome (NAS), a condition associated with in utero exposure to opioids, has been increasing over time. Traditional treatment for NAS combines a formal assessment of symptoms called the Finnegan score and pharmacologic therapy with opioids for infants with scores above a set threshold. Previous research has established that black patients are less likely to receive pain medication relative to white patients. This study examines potential disparities in the receipt of pharmacologic therapy with opioids among infants with prenatal opioid exposure or a diagnosis of neonatal abstinence syndrome among black and white infants. Study Design: This is a prospective cohort design utilizing electronic health record data. Chi‐square and logistic regression models assessing the relationship between pharmacotherapy and race were adjusted for insurance status, gender, maximum Finnegan score received, year of treatment, and facility. Population Studied: A sample of infants who were diagnosed with NAS (defined as ICD‐9: 779.5 or ICD‐10: 96.1) or opioid exposure (defined as ICD‐9: 760.73 or ICD‐10: P04.49) within a large metropolitan hospital system between the years 2008 and 2018 was obtained. Of those infants diagnosed with opioid exposure or NAS (N = 2518), 667 did not have a Finnegan score reported, resulting in a sample loss of 26%. The sample was then limited to black and white infants, dropping an additional 66 observations and resulting in a final sample of N = 1785. All data were taken from the infant’s electronic health records. Principal Findings: Chi‐square tests show that there is no significant difference in receipt of pharmacologic therapy with opioids by gender, or insurance status, but a significantly smaller proportion of black infants receive pharmacologic therapy (P < .001) relative to white infants. In the adjusted logistic model, black infants have significantly decreased odds (OR 0.42; [95% CI: 0.24, 0.73]) of receiving pharmacologic therapy relative to white infants. Conclusions: The health disparities literature has shown that the pain of black patients is undertreated compared with white patients. This study shows that disparities in the use of opioids start in the newborn period for pharmacologic treatment of neonatal abstinence syndrome. To our knowledge, this study is the first to show that the disparity in opioid prescriptions begins at infancy. Implications for Policy or Practice: New trends in NAS management involve an increased focus on nonpharmacologic therapy, such as breastfeeding, skin‐to‐skin contact, soothing, and swaddling. Some hospitals are moving away from the traditional Finnegan scoring and toward a simplified diagnostic model, which only prescribes pharmacologic opioid therapy when infants are not able to eat, sleep, or be consoled. It is important to monitor this transition in NAS management to ensure that treatment paths are determined by the severity of symptoms rather than race. Ensuring equal access to family‐centered NAS models where families are able to room in and provide optimal nonpharmacologic care to their infant should be prioritized. Increased education regarding potential racial biases in prescribing practices and efforts to standardize the care and treatment of opioid‐exposed infants are recommended.