Background: Neonatal abstinence syndrome (NAS) occurs when a neonate is exposed to licit or illicit chemical substances in utero and manifests withdrawal symptoms postnatally. Appropriate identification, documentation, and communication of NAS diagnosis is needed to qualify for federally funded therapies aimed at supporting development through early intervention (EI) programs. Our objective was to assess characteristics associated with successful EI referral and enrollment for NAS due to maternal opioid exposure. A secondary objective was to assess whether successful EI referral and enrollment was associated with opioid-associated vs. nonopioid-associated NAS.
Methods: From January to March 2017, all neonatal discharges at Baystate Medical Center (BMC) were identified utilizing a billing database. 922 discharges were identified, 139 from NICU and 783 from NBN. EMR documentation of neonatal discharges was reviewed manually to identify babies exposed to substances associated with NAS. Neonates with NAS born from April to December 2017 were identified with NAS-associated administrative billing codes. These were combined and manually reviewed to confirm the NAS diagnosis due to maternal use of opiates or other substances associated with NAS, and for patient characteristics documented in the electronic medical record (EMR), including stated race, hospitalization in the NICU for some or all of the hospital course, maternal treatment for OUD with a maintenance opioid (methadone, buprenorphine, or buprenorphine-naloxone), and payor. Neonatal discharges were reviewed, based on data supplied by the Massachusetts Department of Public Health for completion of an individualized family service plan (IFSP) for neonates with NAS associated with opiates (with and without exposure to non-opiates associated with NAS) versus NAS associated with non-opiates only. IFSP completion was considered the furthest step along the pathway to EI enrollment.
Results: A total of 125 discharges of neonates with NAS were identified. 2 discharges were excluded due insufficient information present in the EMR to analyze appropriately, and 12 discharges were excluded due to lack of exposure to chemicals associated with NAS, or exposure insufficiently proximal to delivery, leaving 111 discharges for further analysis. Of these, 89 patients were exposed to opiates +/- nonopiates, and 22 were exposed to non-opiate substances only. Of neonates discharged with a confirmed diagnosis of opiate-associated NAS the following characteristics were found in higher proportions in the group completing IFSP versus those who did not, but did not reach significance using chi-square test of independence (Table 1):NICU hospitalization during primary neonatal course (with or without NBN hospitalization) Black raceCommercial payorMaternal medication assisted treatment (MAT)Of neonates discharged with confirmed diagnosis of opiate-associated NAS (with/without exposure to non-opiates associated with NAS) or NAS associated with non-opiates only, there was not a statistically significant difference in rates of IFSP completion. (Table 2)
Conclusions: For neonates discharged with a diagnosis of NAS due to opiate exposure, characteristics of NICU hospitalization, black race, and commercial payor were associated with a higher rate of IFSP completion for EI, but this was not statistically significant. Successful completion of IFSP was not significantly different in neonates with NAS due to opiates versus exposure to non-opiates alone.
