Maternal drug use and length of neonatal unit stay

Johnson, Kathryn A.; Greenough, Anne; Gerada, Claire

doi:10.1046/j.1360-0443.2003.00391.x

Cited by 54 publications

(49 citation statements)

References 15 publications

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“…[1][2][3][4][5][6][7][8] Healthy People 2010 states a national goal of increasing the proportion of pregnant women who achieve complete abstinence from alcohol to 94%, with 100% abstinence from illicit drugs. 9 Although these goals are necessary given the association of alcohol and drugs to adverse outcomes, they have been difficult to attain.…”

Section: Introductionmentioning

confidence: 99%

“…Potential Early Start patients are identified based on (1) response to the universal self-administered prenatal substance abuse screening questionnaire completed at the first prenatal appointment; (2) clinician referral; (3) self-referral and/or (4) positive urine toxicology screen results on the universal toxicology screening test. Women who are identified as having some risk for alcohol, tobacco or other drug use during pregnancy are then immediately referred to the Early Start Specialist, a licensed clinical social worker or marriage and family therapist, who conducts an in-depth psychosocial assessment with the patient.…”

Section: Introductionmentioning

confidence: 99%

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Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

et al. 2008

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Objective: To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes. Result: SAT women had either similar or slightly higher rates than the control women on most outcomes but significantly lower rates than S women. SA women generally had intermediate rates to the SAT and S groups. In multivariate analysis, the S group had significantly worse outcomes than the SAT group: preterm delivery (odds ratio (OR) ¼ 2.1, 1.3 to 3.2), placental abruption (OR ¼ 6.8, 3.0 to 15.5) and IUFD (OR ¼ 16.2, 6.0 to 43.8).Conclusion: Substance abuse treatment integrated with prenatal visits was associated with a positive effect on maternal and newborn health.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

et al. 2008

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“…Consistent with the increased odds of developing NAS, duration of hospital stay was longer in infants born to polydrug-misusing mothers compared with those taking only methadone. 20 Our cohort represented 2.9% of hospital births but used almost one-fifth of the neonatal cot days during the period of the study.…”

Section: Discussionmentioning

confidence: 99%

“…13 Australian and European data have demonstrated large consumption of healthcare resources by infants born to drug-misusing women, 2,8 but there are few data to quantify this within the UK healthcare setting. [20][21][22] We present data from infants born over a 3-year period to a large cohort of drug-misusing mothers cared for by a specialist service within a large inner-city maternity hospital in the UK.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] There is conflicting evidence with regard to optimal maternal methadone dose in pregnancy, with some studies showing an association between maternal methadone dose and the risk of NAS and some studies showing no such relationship. 9,[13][14][15][16][17][18][19] Duration of stay may be longer for infants born to polydrug-misusing mothers, 20 and since higher doses of methadone have been associated with less polydrug use, reducing methadone during pregnancy may not be justified. 13 Australian and European data have demonstrated large consumption of healthcare resources by infants born to drug-misusing women, 2,8 but there are few data to quantify this within the UK healthcare setting.…”

Section: Introductionmentioning

confidence: 99%

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Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

Dryden

Young

Hepburn

et al. 2009

BJOG

214

205

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Objectives The objectives of this study were to investigate factors associated with the development of neonatal abstinence syndrome (NAS) and to assess the implications for healthcare resources of infants born to drug-misusing women.Design Retrospective cohort study from 1 January 2004 to 31 December 2006.Setting Inner-city maternity hospital providing dedicated multidisciplinary care to drug-misusing women.Population Four hundred and fifty singleton pregnancies of drugmisusing women prescribed substitute methadone in pregnancy.Methods Case note review.Main outcome measures Development of NAS and duration of infant hospital stay.Results 45.5% of infants developed NAS requiring pharmacological treatment. The odds ratio of the infant developing NAS was independently related to prescribed maternal methadone dose rather than associated polydrug misuse. Breastfeeding was associated with reduced odds of requiring treatment for NAS (OR 0.55, 95% CI 0.34-0.88). Preterm birth did not influence the odds of the infant receiving treatment for NAS. 48.4% infants were admitted to the neonatal unit (NNU) 40% of these primarily for treatment of NAS. The median total hospital stay for all infants was 10 days (interquartile range 7-17 days). Infants born to methadone-prescribed drug-misusing mothers represented 2.9% of hospital births, but used 18.2% of NNU cot days.Conclusions Higher maternal methadone dose is associated with a higher incidence of NAS. Pregnant drug-misusing women should be encouraged and supported to breastfeed. Their infants are extremely vulnerable and draw heavily on healthcare resources.Keywords Breastfeeding, health resources, methadone, neonatal abstinence syndrome.

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Model‐Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real‐World Data

Wijekoon

Aduroja

Biggs

et al. 2020

Clin Pharma and Therapeutics

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At least 60% of the neonates with opioid withdrawal syndrome (NOWS) require morphine to control withdrawal symptoms. Currently, the morphine dosing strategies are empiric, not optimal and associated with longer hospital stay. The aim of the study was to develop a quantitative, model-based, real-world data-driven approach to morphine dosing to improve clinical outcomes, such as reducing time on treatment. Longitudinal morphine dose, clinical response (Modified Finnegan Score (MFS)), and baseline risk factors were collected using a retrospective cohort design from the electronic medical records of neonates with NOWS (N = 177) admitted to the University of Maryland Medical Center. A dynamic linear mixed effects model was developed to describe the relationship between MFS and morphine dose adjusting for baseline risk factors using a split-sample data approach (70% training: 30% test). The training model was evaluated in the test dataset using a simulation based approach. Maternal methadone and benzodiazepine use, and race were significant predictors of the MFS response. Positive autocorrelations of 0.56 and 0.12 were estimated between consecutive MFS responses. On an average, for a 1,000 μg increase in the morphine dose, the MFS decreased by 0.3 units. The model evaluation showed that observed and predicted median time on treatment were similar (13.0 vs. 13.8 days). A model-based framework was developed to describe the MFSmorphine dose relationship using real-world data that could potentially be used to develop an adaptive, individualized morphine dosing strategy to improve clinical outcomes in infants with NOWS. Neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome, is a drug withdrawal syndrome experienced by 55-94% of in utero opioid-exposed neonates shortly after birth. 1 The dramatic increase of opioid use in pregnancy has led to a 5-fold increase in NOWS with an incidence of 1.5-8.0 per 1,000 hospital births from 2004 to 2014. 2-4 On average in the United States, 1 infant is born every

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Maternal drug use and length of neonatal unit stay

Abstract: Prolonged treatment and neonatal unit stay are influenced by the type of maternal drug abused.

Cited by 54 publications

References 15 publications

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

Model‐Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real‐World Data

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