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Inclusion of Positive Self-reporting by Mothers of Substance Exposed Neonates Increases the Predictability of NAS Severity Over Toxicology Alone

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Abstract

Objectives

The rise in opioid use among pregnant women has resulted in an increase in the incidence of neonatal abstinence syndrome (NAS). Despite the focus on opioid use, prenatal polysubstance exposure is often associated with NAS diagnosis and severity. Drug toxicology screens such as urine drug screens and umbilical cord toxicology are dependent upon the substance, timing, frequency, and dose to detect substances present and can underestimate the neonatal exposure. The aim of this study was to identify the predictability of the consequences of prenatal polysubstance exposure versus opioid only exposure based on toxicology and toxicology plus self-report.

Methods

Neonates > 35 weeks gestation with prenatal opioid exposure were included in this retrospective data analysis. NAS was identified using maternal urine drug screen (UDS) toxicology, self-reported exposure during pregnancy, and neonatal toxicology. Analysis was conducted using Stata 15.1 utilizing McNemar’s test, chi-square for categorical outcomes, and Wilcoxon test for numerical outcomes.

Results

A statistically significant difference in length of stay and length of treatment with poly-exposed neonates was observed when maternal self-report was considered with toxicology, but not with toxicology alone. This trend was observed for cumulative hospital length of stay as well as length and dose of treatment.

Conclusions for Practice

The findings in this report demonstrate that self-report is important for identifying substance of exposure. Three substances in particular that often require a change in treatment paradigm went undetected by toxicology were Gabapentin (20.9% of the population), Heroin (20.5% of the population), and Benzodiazepines (8.5% of the population). A healthy rapport with patients is often critical to effective clinical practice. Women with substance use disorder anticipate negative reactions from healthcare providers. Empathetic interview techniques to facilitate accurate disclosure may be more important to the treatment of the exposed neonate.

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Fig. 1
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Abbreviations

NICU:

Neonatal Intensive Care Unit

CHH:

Cabell-Huntington Hospital

NAS:

Neonatal Abstinence Syndrome

NTU:

Neonatal Treatment Unit

HCA:

Health Care Authority

IQR:

Interquartile range

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Correspondence to Todd H. Davies.

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The data in this manuscript appear in no prior publications or submissions with any overlapping information, including study and patients. The manuscript has not and will not be submitted to any other journal while it is under consideration by the “Addiction.” The authors have no conflicts of interest to disclose.

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Roth, D., Loudin, S., Andrews, L. et al. Inclusion of Positive Self-reporting by Mothers of Substance Exposed Neonates Increases the Predictability of NAS Severity Over Toxicology Alone. Matern Child Health J 24, 340–350 (2020). https://doi.org/10.1007/s10995-019-02871-9

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Keywords

  • NAS
  • Neonatology
  • Epidemic
  • Withdrawal
  • Opioids