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Am J Perinatol 2024; 41(S 01): e654-e663
DOI: 10.1055/a-1925-1659
Original Article

Severe Neonatal Opioid Withdrawal Requiring Pharmacotherapy: Impact of Region of Residence

Deepika Sankaran 
1   Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
2   Division of Neonatology, Department of Pediatrics, University of California at Davis, Sacramento, California
,
Shikha Rawat
3   Department of Economics, Stony Brook University, Stony Brook, New York
4   Research Analyst, American Express, New York, New York
,
Jennifer L. Kachelmeyer 
1   Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
,
Emily S. Li
1   Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
,
Anne M. Reynolds
1   Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
,
Munmun Rawat
1   Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
,
Praveen Chandrasekharan
1   Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York
› Author Affiliations Funding P.C. was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; grant number: R01HD104909/R03HD096510) and the National Institutes of Health (NIH)/National Heart Lung and Blood Institute (NHLBI; grant no.: K12 HL138052), and research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. D.S. was supported by Children's Miracle Network at UC Davis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funding agencies had no role in the design of this manuscript.
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Abstract

Objectives Our objective was to evaluate the trend and to assess the impact of maternal region of residence in Western New York (WNY), on severe neonatal opioid withdrawal syndrome (NOWS).

Study Design Term infants' born at gestational age greater than or equal to 37 weeks with severe NOWS, defined as withdrawal resulting in the receipt of pharmacologic therapy from WNY admitted to our neonatal intensive care unit (NICU) from January 1, 2008 to December 31, 2016, were included. Severe NOWS admissions to our NICU from the following five regions were controlled with birth and insurance data: (1) Urban North, (2) Erie Coastal, (3) Niagara Frontier, (4) Southern Tier, and (5) Urban South.

Results “Urban South” residence was associated with an increased risk of severe NOWS (adjusted odds ratio = 1.8, 97.5% confidence interval: 1.1–2.9). The trend in admission for severe NOWS doubled between 2008 to 2010 and 2014 to 2016 (p = 0.01). More infants born to maternal nonprescribed opioid users were placed in foster care at discharge (36.5 vs. 1.9%, p < 0.001).

Conclusion In WNY, neonates born to mothers from the “Urban South” were twice at risk of being admitted for severe NOWS. One-third of infants with severe NOWS after nonprescribed opioid use were placed in foster care. Implementing targeted strategies at the community level may help improve outcomes in NOWS.

Key Points

  • Maternal region of residence is a risk factor for severe neonatal opioid withdrawal.

  • Admissions for severe neonatal opioid withdrawal trended up from 2008 to 2010 to 2014 to 2016.

  • One-third of the infants born to mothers on nonprescribed opioids were discharged to foster care.

Keywords

severe neonatal opioid withdrawal syndrome - region of residence - neonatal intensive care unit - trends in severe NOWS

Note

The data were previously presented as a poster in Pediatric Academic Societies meeting and in the Eastern Society of Pediatrics Research meeting in 2019.


Authors' Contributions

D.S., S.R., J.L.K., E.S.L., A.M.R., M.R., and P.C. made substantial contributions to conception, design, and drafting of the manuscript. All the authors have critically revised and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 30 January 2022

Accepted: 01 August 2022

Accepted Manuscript online:
16 August 2022

Article published online:
31 December 2022

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