The new prediction model could make it easier to find which children will develop NAS

Reviewed by Emily Henderson, B.Sc.November 12, 2020

A new prediction model designed by Vanderbilt could make it easier to determine which babies will develop neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in newborns that occurs after exposure to opioids during pregnancy.

According to the recommendations of the American Academy of Pediatrics (AAP), most newborns exposed to opioids are kept in the hospital for four to seven days to be monitored for developing NAS and sometimes away from their mothers, as opposed to one or three days for infants who have not been exposed.

It is a one-size-fits-all treatment approach that can result in excessive hospitalization and costs with little benefit (if withdrawal does not occur) and a disruption of the bond between mothers and babies. Failure to identify high-risk infants for NAS at birth can also result in treatment delays.

Our research team found that opioid use in pregnancy and NAS has grown dramatically over the past two decades. “

Stephen Patrick, MD, MPH, MS, neonatologist at Monroe Carell Jr. Children’s Hospital in Vanderbilt and associate professor of pediatrics and health policy

Patrick, director of the Vanderbilt Center for Child Health Policy and lead author of the Journal of Pediatrics study on the new prediction model, said the number of mothers diagnosed with opioid use disorder quadrupled and the rate of infants diagnosed with NAS it has grown nearly sevenfold. over the past two decades. By 2016, one child was diagnosed with the syndrome on average every 15 minutes nationwide, resulting in a hospital cost of over $ 500 million.

Until now, there were no accurate clinical tools to guide the management of opioid-exposed babies after birth.

“But we need to guide some of the first steps we take for children – how we observe them, based on their risk, as opposed to treating all children equally,” Patrick said.

“Although the AAP recommends that children exposed to opioids be observed in the hospital for 4-7 days after birth, we wondered if it was possible to discharge children home earlier with the right support.”

The tool, which will be tested further before being widely implemented, provides the ability to understand what percentage of children exposed to opioids develop abstinence.

“We estimate that around 100,000 opioid-exposed babies are born each year and many are over-observed,” said Patrick.

William Cooper, MD, Cornelius Vanderbilt Chair in Pediatrics and senior author of the study, added, “Immediately after birth, we often find it difficult to identify which children with opioid exposure are safe to be discharged. Having a tool like this will help us determine the best kind of assistance to provide in these situations “.

The researchers came up with a variable based on several factors, including the baby’s gestational age, whether they are premature, the types of opioids they were exposed to, and even whether they were exposed to cigarettes and other drugs such as benzodiazepines.

“We came up with” what does the literature say? What does our previous work say? What does our clinical experience say in terms of which factors may increase the risk of drug withdrawal? “Then we tested these factors to see what things actually increase the risk of withdrawal,” Cooper said.

The researchers developed two predictive models for NAS -; one, a simple “general population” model, and the other, for use with a subset of individuals with hepatitis C virus infection or opioid exposure in the past 30 days (the highest risk model).

Although newborns exposed to opioids are not routinely cared for in the Neonatal Intensive Care Unit (NICU) at the Children’s Hospital, they are routinely treated in the NICU in other hospitals, Patrick said.

Being able to scour babies who are unlikely to develop NAS would prevent them from having to be kept in NICU at these other hospitals, Patrick said.

Opioid use among pregnant women is very different among patients -; some women may be in the long term recovery phase for opioid use disorder, taking medications to improve pregnancy outcomes. These are the women who have children who could potentially be discharged sooner. “It would be really useful,” Patrick said.

As Vanderbilt investigators continue to test the model, an interactive web tool is available on the Center for Child Health Policy website, www.childpolicy.org/NASrisk.