Abstract

NM-280

Neonatal Abstinence Syndrome: Kentucky Children's Hospital's Experience with Outcome Measures and Disposition

¹Robles A, ²Weaver R, ¹Withers B, ¹DiLorenzo A, ¹Reddy A
¹University of Kentucky, Lexington, Kentucky, United states; ²Cincinnati Children's Hospital, Cincinnati, OH, USA

Introduction
Neonatal Abstinence Syndrome(NAS)depicts a withdrawal syndrome in neonates with in utero exposure to drugs, mainly opioids.1 Symptoms include central nervous system irritability, hypersensitive autonomic nervous system, respiratory distress, and gastrointestinal irritability.1,2
NAS is a symptom of a growing epidemic. As per the CDC, US incidence of NAS has increased by 400% from 2000 to 2012.3,4 In 2012, an uncomplicated peripartum hospital course for a term neonate could anticipate a mean length of stay of 2.1 days and a charge of $3,500; contrastingly an infant with NAS had an average hospital stay of 16.9 days and charge of $66,700.4
We designed this study to examine our institution’s experience with NAS, as well as its impact on outcomes and disposition.
Methods
Retrospective analysis was completed of a single institution database after obtaining IRB approval. Eligible patients were neonates admitted to the NICU at Kentucky Children’s Hospital over two six month periods five years apart(January 1,2011-June 30,2011 and January 1,2016-June 30,2016)with a diagnosis of NAS.
Statistical analysis was completed using standard methods including: a pooled t test for comparison of means and a two sample proportion z test for data involving sample proportions. Relative risk ratio was calculated for statistically significant factors.
Results
163 patients met our inclusion criteria. We accrued 51 patients in 2011 and 112 in 2016. We noted an increase in NAS neonates mechanically ventilated from 23.5% in 2011 to 34% in 2016 thereby substantially increasing cost. There were also changes in substances used. In 2011, suboxone and methadone exposure both were 15%. In 2016, suboxone exposure increased to 66% while methadone decreased to 8.9%. Heroin exposure went up from 0% in 2011 to 18.8% in 2016. Comparing data from 2011 to 2016, there has also been a trend in discharging these neonates to a second degree relative(26% vs 32%)versus non-relative foster home(28% vs 15.6%).
On assessing data from our patient population as a whole, we had several interesting findings. Maternal methadone use was predictive of an APGAR≥8 at 0 minutes(p=0.03)and approaches predictive value at 5 minutes(p=0.053).
Maternal methadone use was less likely associated with neonatal respiratory distress(p=0.04). Additionally, infants with in utero exposure to methadone were less likely to be mechanical ventilated during their hospitalization compared to those with other substance exposures(p=0.04).
Discussion
Exposure to methadone in utero had better APGAR scores. Suboxone exposure had decreased incidence of respiratory distress and mechanical ventilation. Most infants discharged with NAS were released to non-parental guardianship.
Conclusion
Among Substances used, maternal methadone was least likely to produce neonatal respiratory distress syndrome. Disposition has transitioned from a non-relative foster family to second degree relative placement.