Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA (Current Affiliation), United States of America; Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America.
Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America.
Neurotoxicol Teratol. 2021 Jul-Aug;86:106975. doi: 10.1016/j.ntt.2021.106975. Epub 2021 Mar 23.
The opioid epidemic in the United States has led to a significant increase in the incidence of neonatal opioid withdrawal syndrome (NOWS); however, the understanding of long-term consequences of NOWS is limited. The objective of this study was to evaluate post-discharge healthcare utilization in infants with NOWS and examine the association between NOWS severity and healthcare utilization. A retrospective cohort design was used to ascertain healthcare utilization in the first year after birth-related discharge using the CERNER Health Facts® database. ICD-9/ICD-10 diagnostic codes were used to identify live births and to classify infants into two study groups: NOWS and uncomplicated births (a 25% random sample). Evaluated outcomes included rehospitalization, emergency department (ED) visits within 30-days and one-year after discharge, and a composite one-year utilization event (either hospitalization or emergency department visit during that year). NOWS severity was operationalized as pharmacologic treatment, length of hospitalization, and medical conditions often associated with NOWS. In 3,526 infants with NOWS (restricted to gestational age ≥ 33 weeks), NOWS severity was associated with an increase in composite one-year utilization (OR: 1.1; 95% CI: 1.04-1.2) after adjusting for prematurity, sepsis, jaundice, use of antibiotics, infant sex, insurance status, race, hospital bed size, year of birth, and census division. In a subset of full-term infants (3008 with NOWS and 88,452 uncomplicated births), having a NOWS diagnosis was associated with higher odds of a 30-day (OR: 1.6; 95% CI: 1.03-2.4) and one-year rehospitalization (OR: 1.6; 95% CI: 1.1-2.4) after adjusting for infant sex, race, type of medical insurance, hospital location, census division, year of primary encounter, hospital bed size, and medical conditions. This study found higher healthcare utilization during the first year of life in infants diagnosed with NOWS, especially those with severe NOWS. Findings suggest a need for closer post-discharge follow-up and management of infants with NOWS.
美国的阿片类药物流行导致新生儿阿片类戒断综合征（NOWS）的发病率显著增加；然而，对于 NOWS 的长期后果的理解是有限的。本研究的目的是评估患有 NOWS 的婴儿出院后的医疗保健利用情况，并研究 NOWS 严重程度与医疗保健利用之间的关系。使用 CERNER Health Facts®数据库，采用回顾性队列设计，确定与出生相关的出院后一年内的医疗保健利用情况。使用 ICD-9/ICD-10 诊断代码来确定活产，并将婴儿分为两个研究组：NOWS 和无并发症的分娩（随机抽取 25%）。评估的结果包括出院后 30 天内和一年内的再次住院、急诊就诊，以及一年内的综合利用事件（当年住院或急诊就诊）。NOWS 的严重程度通过药物治疗、住院时间和与 NOWS 相关的常见医疗状况来操作化。在 3526 名患有 NOWS 的婴儿（仅限于胎龄≥33 周）中，在调整了早产、败血症、黄疸、使用抗生素、婴儿性别、保险状况、种族、医院床位大小、出生年份和人口普查分区后，NOWS 严重程度与综合一年利用率的增加相关（比值比：1.1；95%置信区间：1.04-1.2）。在一个足月婴儿的亚组中（3008 名患有 NOWS 和 88452 名无并发症的分娩），诊断为 NOWS 与 30 天（比值比：1.6；95%置信区间：1.03-2.4）和一年再住院（比值比：1.6；95%置信区间：1.1-2.4）的可能性更高，调整了婴儿性别、种族、医疗保险类型、医院位置、人口普查分区、主要就诊年份、医院床位大小和医疗状况。本研究发现，患有 NOWS 的婴儿在生命的第一年中医疗保健利用率更高，尤其是那些患有严重 NOWS 的婴儿。研究结果表明，需要对患有 NOWS 的婴儿进行更密切的出院后随访和管理。
