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Kim K, Liu G, Dick AW, Choi SW, Agbese E, Corr TE, Hsuan C, Wright MS, Park S, Velott D, Leslie DL. Timing of treatment for opioid use disorder among birthing people. J Subst Use Addict Treat 2024; 161:209289. [PMID: 38272119 PMCID: PMC11090704 DOI: 10.1016/j.josat.2024.209289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated. METHODS Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people. RESULTS Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32). CONCLUSION Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
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Affiliation(s)
- Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Sung W Choi
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tammy E Corr
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Charleen Hsuan
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Megan S Wright
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Law, University Park, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Sujeong Park
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Diana Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Roberts SCM, Schulte A, Zaugg C, Leslie DL, Corr TE, Liu G. Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment. JAMA Netw Open 2023; 6:e2327138. [PMID: 37535355 PMCID: PMC10401306 DOI: 10.1001/jamanetworkopen.2023.27138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/23/2023] [Indexed: 08/04/2023] Open
Abstract
Importance Research has found associations of pregnancy-specific alcohol policies with increased low birth weight and preterm birth, but associations with other infant outcomes are unknown. Objective To examine the associations of pregnancy-specific alcohol policies with infant morbidities and maltreatment. Design, Setting, and Participants This retrospective cohort study used outcome data from Merative MarketScan, a national database of private insurance claims. The study cohort included individuals aged 25 to 50 years who gave birth to a singleton between 2006 and 2019 in the US, had been enrolled 1 year before and 1 year after delivery, and could be matched with an infant. Data were analyzed from August 2021 to April 2023. Exposures Nine state-level pregnancy-specific alcohol policies obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System. Main Outcomes and Measures The primary outcomes were 1 or more infant injuries associated with maltreatment and infant morbidities associated with maternal alcohol consumption within the first year. Logistic regression, adjusting for individual-level and state-level controls, and fixed effects for state, year, state-specific time trends, and SEs clustered by state were used. Results A total of 1 432 979 birthing person-infant pairs were included (mean [SD] age of birthing people, 32.2 [4.2] years); 30 157 infants (2.1%) had injuries associated with maltreatment, and 44 461 (3.1%) infants had morbidities associated with alcohol use during pregnancy. The policies of Reporting Requirements for Assessment/Treatment (adjusted odds ratio [aOR], 1.28; 95% CI, 1.08-1.52) and Mandatory Warning Signs (aOR, 1.18; 95% CI, 1.10-1.27) were associated with increased odds of infant injuries but not morbidities. Priority Treatment for Pregnant Women Only was associated with decreased odds of infant injuries (aOR, 0.83; 95% CI, 0.76-0.90) but not infant morbidities. Civil Commitment was associated with increased odds of infant injuries (aOR, 1.26; 95% CI, 1.08-1.48) but decreased odds of infant morbidities (aOR, 0.57; 95% CI, 0.53-0.62). Priority Treatment for Pregnant Women and Women With Children was associated with increased odds of both infant injuries (aOR, 1.12; 95% CI, 1.00-1.25) and infant morbidities (aOR, 1.08; 95% CI, 1.03-1.13). Reporting Requirements for Child Protective Services, Reporting Requirements for Data, Child Abuse/Neglect, and Limits on Criminal Prosecution were not associated with infant injuries or morbidities. Conclusions and Relevance In this cohort study, most pregnancy-specific alcohol policies were not associated with decreased odds of infant injuries or morbidities. Policy makers should not assume that pregnancy-specific alcohol policies improve infant health.
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Affiliation(s)
- Sarah C. M. Roberts
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
| | - Alex Schulte
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
| | - Claudia Zaugg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Tammy E. Corr
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Hohman EE, Corr TE, Kawasaki S, Savage JS, Symons Downs D. Nutritional Status Differs by Prescription Opioid Use among Women of Reproductive Age: NHANES 1999-2018. Nutrients 2023; 15:nu15081891. [PMID: 37111110 PMCID: PMC10144164 DOI: 10.3390/nu15081891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Prescription opioid use among pregnant women has increased in recent years. Prenatal exposure to opioids and poor nutrition can both negatively impact maternal-fetal outcomes. The objective of this study was to characterize the nutrition and health status of reproductive-age women taking prescription opioids, compared to women not taking opioids. Using NHANES 1999-2018 data, non-pregnant women aged 20-44 years were classified as taking a prescription opioid in the last 30 days (n = 404) or unexposed controls (n = 7234). Differences in anthropometric, cardiovascular, hematologic, and micronutrient status indicators between opioid-exposed and unexposed women were examined. Opioid-exposed women were older, had lower income and education, and were more likely to be non-Hispanic White, to smoke, and to have chronic health conditions compared to unexposed women. In unadjusted analyses, several nutrition and health markers were significantly different between opioid exposure groups. After controlling for covariates, women taking opioids had higher odds of Class II (OR = 1.6, 95% CI = 1.1-2.3) or III obesity (OR = 1.6, 95% CI = 1.1-2.5), and lower levels of serum folate, iron, and transferrin saturation. Reproductive-age women taking prescription opioids may be at risk for poorer nutritional and cardiometabolic health. Future research is needed to explore whether nutritional status impacts maternal-fetal outcomes for women exposed to opioids during pregnancy.
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Affiliation(s)
- Emily E Hohman
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA 16802, USA
| | - Tammy E Corr
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Sarah Kawasaki
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA 16802, USA
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA
| | - Danielle Symons Downs
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA 17033, USA
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Mackeen AD, Vigh RS, Davis LB, Satti M, Cumbo N, Pauley AM, Leonard KS, Stephens M, Corr TE, Roeser RW, Deimling T, Legro RS, Pauli JM, Downs DS. Obstetricians' prescribing practices for pain management after delivery. Pain Manag 2022; 12:645-652. [PMID: 35289656 PMCID: PMC10015511 DOI: 10.2217/pmt-2021-0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine postpartum opioid prescribing practices. Materials & methods: Obstetricians were interviewed about opioids: choice of opioid, clinical factors considered when prescribing, thoughts/beliefs about prescribing, and typical counseling provided. Inductive thematic analyses were used to identify themes. Results: A total of 38 interviews were analyzed. Several key points emerged. The choice of opioid, dosing and number of pills prescribed varied widely. The mode of delivery is the primary consideration for prescribing opioids. All providers would prescribe opioids to breastfeeding women. Some providers offered counseling on nonopioid treatment of pain. Discussion: At two large tertiary centers in Pennsylvania, the 38 physicians interviewed wrote 38 unique opioid prescriptions. Patient counseling addressed short-term pain management, but not the chronic overuse of opioids.
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Affiliation(s)
- A Dhanya Mackeen
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA 17822, USA
| | - Richard S Vigh
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA 17822, USA
| | - Lisa Bailey Davis
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
| | - Mohamed Satti
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Geisinger, Danville, PA 17822, USA
| | - Nicole Cumbo
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Mark Stephens
- Department of Family & Community Medicine, Penn State College of Medicine, University Park, PA 16802, USA
| | - Tammy E Corr
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - R W Roeser
- Department of Human Development and Family Studies, College of Health and Human Development, Pennsylvania State University, University Park, PA 16802, USA
| | - Timothy Deimling
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Richard S Legro
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Jaimey M Pauli
- Department of Obstetrics & Gynecology, Penn State Health, Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Danielle Symons Downs
- Departments of Kinesiology, College of Health & Human Development, & Obstetrics & Gynecology, Penn State College of Medicine, The Pennsylvania State University, University Park, PA 16802, USA
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Batra EK, Lewis M, Saravana D, Corr TE, Daymont C, Miller JR, Hackman NM, Mikula M, Ostrov BE, Fogel BN. Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology. Pediatrics 2021; 148:183392. [PMID: 34851414 DOI: 10.1542/peds.2020-033704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children's hospital. METHODS A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.
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Affiliation(s)
- Erich K Batra
- Departments of Family and Community Medicine.,Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Mary Lewis
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Deepa Saravana
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Tammy E Corr
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Carrie Daymont
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Jennifer R Miller
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Nicole M Hackman
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Margaret Mikula
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.,Samaritan Health Services, Corvallis, Oregon
| | - Barbara E Ostrov
- Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Benjamin N Fogel
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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6
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Corr TE, Xing X, Liu G. Longitudinal Health Care Utilization of Medicaid-Insured Children with a History of Neonatal Abstinence Syndrome. J Pediatr 2021; 233:82-89.e1. [PMID: 33545189 DOI: 10.1016/j.jpeds.2021.01.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe longitudinal health care utilization of Medicaid-insured children with a history of neonatal abstinence syndrome (NAS) compared with similar children without NAS. STUDY DESIGN Retrospective, longitudinal cohort study. Data were extracted from the Medicaid Analytic eXtract files for all available states and DC from 2003-2013. Subjects were followed up to 11 years. In total, 17 229 children with NAS were identified using the International Classification of Diseases, Ninth Revision code 779.5. Children without NAS, matched on demographic and health variables, served as the comparison group. Outcomes were number of claims for inpatient, outpatient, and emergency department encounters, numbers of prescription claims, and costs associated with these services. Linked claims were identified for each subject using a unique, within-state ID. RESULTS Children with NAS had increased claims for inpatient admissions (marginal effect [ME] 0.49; SE 0.01) and emergency department visits (ME 0.30; SE 0.04) through year 1; increased prescriptions (ME 1.45; SE 0.08, age 0) (ME 0.69; SE 0.11, age 1 year) through year 2; and increased outpatient encounters (ME 20.13; SE 0.54, age 0) (ME 3.95; SE 0.62, age 1 year) (ME 2.90; SE 1.11, age 2 years) through year 3 after adjusting for potential confounders (P < .01 for all). Beyond the third year, health care utilization was similar between those with and without NAS. CONCLUSIONS Children with a diagnosis of NAS have greater health care utilization through the third year of life. These differences resolve by the fourth year. Our results suggest resolution of disparities may be due to shifts in developmental health management in school-age children and inability to track relevant diagnoses in a health care database.
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Affiliation(s)
- Tammy E Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Xueyi Xing
- Evidence-to-Impact Collaborative, Social Science Research Institute, Penn State University, State College, PA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, Oji-Mmuo CN, Mola SJ, Murray YL, Palmer TW, Singh M, Fricchione A, Arnold J, Prentice D, Bridgeman CR, Smith BM, Gavigan PJ, Ericson JE, Miller JR, Pauli JM, Williams DC, McSherry GD, Legro RS, Iriana SM, Kaiser JR. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol 2020; 40:987-996. [PMID: 32439956 PMCID: PMC7241067 DOI: 10.1038/s41372-020-0695-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/13/2023]
Abstract
There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.
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Affiliation(s)
- Shaili Amatya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Tammy E Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chintan K Gandhi
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kristen M Glass
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mitchell J Kresch
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dennis J Mujsce
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christiana N Oji-Mmuo
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sara J Mola
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yuanyi L Murray
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Timothy W Palmer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Meenakshi Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ashley Fricchione
- Neonatal Intensive Care Unit, Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jill Arnold
- Neonatal Intensive Care Unit, Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Danielle Prentice
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Colin R Bridgeman
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Brandon M Smith
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Patrick J Gavigan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessica E Ericson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jennifer R Miller
- Division of Academic General Pediatrics, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Duane C Williams
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - George D McSherry
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sarah M Iriana
- Division of Academic General Pediatrics, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffrey R Kaiser
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA.
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Liu G, Kong L, Leslie DL, Corr TE. A Longitudinal Healthcare Use Profile of Children with a History of Neonatal Abstinence Syndrome. J Pediatr 2019; 204:111-117.e1. [PMID: 30270164 DOI: 10.1016/j.jpeds.2018.08.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe healthcare use over time of children with a history of neonatal abstinence syndrome (NAS) compared with children without NAS. STUDY DESIGN In this retrospective, longitudinal cohort study, data were obtained from MarketScan Commercial Claims and Encounters database from 2005 to 2014. Children with and without NAS based on International Classification of Diseases, Ninth Revision diagnostic codes were followed until 8 years or disenrollment (mean: 35 months). Numbers of claims for inpatient, outpatient, and emergency department encounters; prescription drugs; and costs associated with these encounters were evaluated. RESULTS Children with NAS had a significantly greater number of claims per year from age 1 to 8 for inpatient hospitalizations (adjusted mean ratio 3.20; 95% CI 1.74-5.90), outpatient encounters (1.23; 1.08-1.41), and emergency department visits (1.46; 1.25-1.70) after we adjusted for confounders. Subsequently, adjusted mean annualized costs were nearly double for all healthcare services in children with NAS (1.86; 1.34-2.60) and >4 times as high as for inpatient hospitalizations (4.34; 2.03-9.30) compared with children without NAS. CONCLUSIONS Children with a diagnosis of NAS have significantly greater rates of healthcare use through age 8 years compared with children without NAS. These findings suggest that children affected by NAS have medical disparities that linger well beyond early infancy.
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Affiliation(s)
- Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA
| | - Tammy E Corr
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Hershey, PA.
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9
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Abstract
Background Infants with neonatal abstinence syndrome (NAS) initially experience neurologic excitability, poor feeding, and/or hyperphagia in the setting of increased metabolic demand. Because the longitudinal effects of these early symptoms and behaviors on weight trends are unknown, we sought to contrast weight gain patterns through age 1 year for infants diagnosed with NAS with matched controls. Methods Retrospective cohort of 70 singletons with a gestational age of ≥37 weeks and an ICD-9 or ICD-10 diagnosis of NAS made ≤7 days after birth with institutional follow-up matched to patients without NAS. Infants were matched on gestational age (±2 weeks), birth weight (±20 g), sex (exact), and insurance type (exact). Quantile regression methods were used to estimate 10th, 25th, 50th, 75th and 90th percentiles of weight over time. Results The mean gestational age for an infant with NAS was 38.8 weeks (standard deviation [SD], 1.3). The mean birth weight was 3.141 kg (SD, 0.510). NAS patients had a median of 24 weights recorded between birth and 400 days (inter-quartile range [IQR], 16–32 weights). Patients without NAS had a median of 12 weights recorded (IQR, 10–16). Growth curves were similar over the first 400 days of life. Patients with NAS had non-significantly higher and lower estimated weights for the 90th and 10th percentiles, respectively. Conclusion Infants with a diagnosis of NAS grew similarly to controls during their first year. Given the frequently-encountered NAS symptoms of hyperphagia and irritability, future studies may evaluate whether early differences in caregiver feeding exist and whether they have longer-term impacts on growth.
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Affiliation(s)
- Tammy E Corr
- Penn State College of Medicine, Department of Pediatrics, P.O. Box 850, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Eric W Schaefer
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - Ian M Paul
- Penn State College of Medicine, Department of Pediatrics, P.O. Box 850, 500 University Drive, Hershey, PA, 17033-0850, USA.,Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
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Corr TE, Hollenbeak CS. The economic burden of neonatal abstinence syndrome in the United States. Addiction 2017; 112:1590-1599. [PMID: 28612362 DOI: 10.1111/add.13842] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/10/2016] [Accepted: 04/03/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS While hospital charges related to neonatal abstinence syndrome (NAS) have increased recently, there are no data available regarding costs. Therefore, we sought to describe the NAS population and compare with the non-NAS population, determine the incidence of NAS in the United States and estimate the total annual costs and hospital days of NAS admissions, and estimate the incremental costs and length of stay of an NAS admission compared with a non-NAS admission. DESIGN Retrospective, observational study. Data were obtained from the Kids' Inpatient Database (2003-12). Survey-weighting was used to obtain national counts of NAS births. The incremental burden of costs and length of stay were estimated for NAS admissions and compared to non-NAS admissions. SETTING United States hospitals from states participating in the Kids' Inpatient Database (KID), a nationally representative sample of all-payer in-patient pediatric discharges. PARTICIPANTS Infants with a diagnosis of NAS (27 943) were identified from the KID using ICD-9-CM codes and compared with non-NAS infants (3 783 629). MEASUREMENTS Primary outcome measures were provider costs and length of stay for NAS and non-NAS admissions. Costs were calculated using cost-to-charge ratios and were adjusted for inflation to 2014 US dollars. FINDINGS Between 2003 and 2012, NAS admissions increased more than fourfold, resulting in a surge in annual costs from US$61 million and 67 869 hospital days in 2003 to nearly US$316 million and 291 168 hospital days in 2012. For an infant affected by NAS, the hospital stay was nearly 3.5 times as long (16.57 hospital days compared with 4.98 for a non-NAS patient, P < 0.001) and the costs more than three times greater (US$16 893 compared to US$5610 for a non-affected infant, P < 0.001). CONCLUSION The incidence of neonatal abstinence syndrome is increasing in the United States, and carries an enormous burden in terms of hospital days and costs. The number of US hospital admissions involving neonatal abstinence syndrome increased more than fourfold between the years 2003 and 2012. In 2012, neonatal abstinence syndrome cost nearly $316 million in the United States.
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Affiliation(s)
- Tammy E Corr
- Penn State College of Medicine, Department of Pediatrics, Division of Newborn Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher S Hollenbeak
- Departments of Surgery and Public Health Sciences, Division of Outcomes Research and Quality, Penn State College of Medicine, Hershey, PA, USA
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