Factors Associated With the Need for Pharmacological Management of Neonatal Opioid Withdrawal Syndrome.

BACKGROUND: Neonatal opioid withdrawal syndrome (NOWS) is a significant and growing health problem that affects more than 23,000 infants annually, with an estimated hospital cost of more than $720 million. PURPOSE: The purpose of this study was to examine factors associated with the need to initiate medication for the treatment of NOWS. METHODS: A retrospective review of medical records was conducted of 204 infants born to mothers who used opioids during pregnancy from April 2011 to September 2017. Associations between maternal, infant, and environmental factors and the need for neonatal pharmacological management were examined using χ, t tests, and regression analysis. RESULTS: Of 204 neonates exposed to opioids prenatally, 121 (59%) developed symptoms of NOWS, requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages (37.7 weeks vs 36.4 weeks; P < .001), and mothers were present at the neonate's bedside for a lower proportion of their total hospital stay (57% vs 74% of days; P < .001). Maternal factors associated with the need for neonatal medication treatment included the mother's reason for opioid use (P = .014), primary type of opioid used (P < .001), tobacco use (P = .023), and use of benzodiazepines (P = .003). IMPLICATIONS FOR PRACTICE: This research provides information regarding the proportion of infants exposed to opioids prenatally who develop NOWS that requires treatment, as well as maternal, infant, and environmental factors associated with the need for neonatal medication use. IMPLICATIONS FOR RESEARCH: Future research is needed to examine these relationships prospectively in a larger and more diverse sample.

Policy perceptions of US state public health and child and family services regarding maternal opioid use and neonatal exposure.

OBJECTIVE: To explore how state legislatures and departments of health are responding to the public health and economic issues of increases in opioid use disorder and the impact on pregnant women and infants. DESIGN: The design was a non-experimental descriptive study using a mixed methods survey research approach. SETTING: Electronic and telephone survey of individuals from state departments of health associated with departments of behavioral health and substance use, or child and family services. PARTICIPANTS: Fifty-two respondents employed by individual state departments of health and child and family services. METHODS: Univariate analysis and frequency distribution of ordinal variables was completed. Thematic analysis was used to analyze free text questions and identify themes. RESULTS: All states reported recent changes or plans to address the problem of opioid misuse in their state. Many respondents feel their state continues to lack adequate services for treatment. Some states are exploring unique methods for addressing this in a safe and timely fashion, such as moving medication-assisted treatment to primary care and expanding licensure to Primary Care Physicians (PCPs) and nurse practitioners. CONCLUSIONS: Our findings demonstrate an increased commitment throughout the United States to enhance access to clinically appropriate treatment of substance use disorder particularly during pregnancy, consider unique methods for addressing the problem of opioid dependency, and increase education and primary prevention programs.