Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA; United States Public Health Service, Commissioned Corps, Rockville, MD, USA.
College of Public Health and Human Sciences, Oregon State University, USA.
Drug Alcohol Depend. 2021 Jun 1;223:108704. doi: 10.1016/j.drugalcdep.2021.108704. Epub 2021 Apr 20.
We sought to describe healthcare utilization of infants by maternal opioid exposure and neonatal abstinence syndrome (NAS) status.
A longitudinal cohort of 81,833 maternal-infant dyads were identified from Oregon's 2008-2012 linked birth certificate and Medicaid eligibility and claims data. Chi-square tests compared term infants (≥37 weeks of gestational age) by maternal opioid exposure, defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes or prescription fills, and NAS, defined using ICD-9-CM codes, such that infants were categorized as Opioid+/ NAS+, Opioid+/NAS-, Opioid-/NAS+, and Opioid-/NAS-. Modified Poisson regression was used to calculate adjusted risk ratios (aRR) and 95 % confidence intervals (CI) for healthcare utilization for each infant group compared to Opioid-/NAS- infants.
The prevalence of documented maternal opioid exposure was 123.1 per 1000 dyads and NAS incidence was 5.8 per 1000 dyads. Compared to Opioid-/NAS- infants, infants with maternal opioid exposures were more likely to be hospitalized within 4 weeks (Opioid+/ NAS+: [aRR: 4.7; 95 % CI: 4.3-5.1]; Opioid+/ NAS-: [aRR: 3.7; 95 %CI: 3.1-4.5]) and a year after birth (Opioid+/ NAS+: [aRR: 3.7; 95 %CI: 3.4-4.0]; Opioid+/ NAS-: [aRR: 2.8; 95 %CI: 2.3-3.4]). Infants with maternal opioid exposure and/or NAS were more likely than Opioid-/NAS- infants to have ≥2 sick visits and any ED visits in the year after birth.
Infants with NAS and/or maternal opioid exposure had greater healthcare utilization than infants without NAS or opioid exposure. Efforts to mitigate future hospitalization risk and encourage participation in preventative services within the first year of life may improve outcomes.
我们旨在描述产妇阿片类药物暴露和新生儿戒断综合征（NAS）状况对婴儿医疗保健利用的影响。
我们从俄勒冈州 2008-2012 年的出生证明和医疗补助资格及报销数据中确定了 81833 对母婴队列。通过产妇阿片类药物暴露（使用国际疾病分类，第九修订版，临床修正版[ICD-9-CM]诊断代码或处方）和 NAS（使用 ICD-9-CM 代码），对足月婴儿（≥37 孕周）进行卡方检验，以此将婴儿分为阿片类药物+/NAS+、阿片类药物+/NAS-、阿片类药物-/NAS+和阿片类药物-/NAS-。采用校正泊松回归计算每个婴儿组与阿片类药物-/NAS-婴儿相比医疗保健利用率的调整风险比（aRR）和 95%置信区间（CI）。
有记录的产妇阿片类药物暴露率为 123.1/1000 对，NAS 发生率为 5.8/1000 对。与阿片类药物-/NAS-婴儿相比，产妇阿片类药物暴露的婴儿在 4 周内（阿片类药物+/NAS+：[aRR：4.7；95%CI：4.3-5.1]；阿片类药物+/NAS-：[aRR：3.7；95%CI：3.1-4.5]）和出生后 1 年（阿片类药物+/NAS+：[aRR：3.7；95%CI：3.4-4.0]；阿片类药物+/NAS-：[aRR：2.8；95%CI：2.3-3.4]）更易住院。与阿片类药物-/NAS-婴儿相比，有产妇阿片类药物暴露和/或 NAS 的婴儿在出生后 1 年内更易有≥2 次就诊和任何急诊就诊。
有 NAS 和/或产妇阿片类药物暴露的婴儿比无 NAS 或阿片类药物暴露的婴儿有更高的医疗保健利用率。未来减少住院风险并鼓励在生命的第一年参与预防服务的努力可能会改善结局。
