Neurodevelopmental Outcomes of Children with …

Neurodevelopmental Outcomes of Children with Prenatal Opiate Exposure

Henrietta S. Bada, MD, MPH Professor and Vice Chair, Academic Affairs

Department of Pediatrics College of Medicine

University of Kentucky

Dr. Bada has no conflicts of interest She has documented that she has nothing to disclose.

Outline

? Epidemiologic significance of NAS ? Potential factors that may affect short term

and long term outcomes ? Studies of outcomes post discharge in the first

few years of life ? Reported outcomes on opiate exposed

children at later ages to early adolescence ? Effects of other drug exposures ? Factors that may change outcome trajectories

Lexington Herald-Leader Source: Drug Enforcement Administration

NAS Hospitalizations (Kentucky Newborns)

Number 1200

NAS

1000

800

1015 955 889

730

600 400 200

0

524 470 361 285 241 143 176 182 67 99

1 2 3 4 5 6 7 8 9 10 11 12 13 14 Years 2001 to 2014

16-fold increase (from 1.3/1000 to 20.3/1000 hospital births)

Kentucky Epidemic

2014: 1015 2013: 955 2012: 889

1.3/1000

0.58/1000

9/1000

35-fold increase

20.3/1000

NAS Hospitalizations (Kentucky Newborns)

Number 800 700 600 500 400 300 200 100 67

NAS Medicaid

81% Medicaid

730

590

524 470

434

361

354

285 241

263

176 182 143

99

0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Neonatal Abstinence Syndrome

? NAS will not disappear

? Will only increase and or evolve from different opioid formulation or Rx

2013-2015

Heroin 1960's

Buprenorphine+/Naloxone, Methadone, other opioids

Mid 2000s to present

Methadone 1970 ? 1980s

Other opioids

(oxycodone, hydro-morphone,

tramadol)

1990s - 2000s

Methadone, Hydro-

morphone

Cocaine

1980-1990s

Perinatal Factors That May Affect Long-term Outcomes

? Duration of in utero drug exposure ? Dose-effect relationship ? Maternal polydrug use (legal, other Rx, illegal) ? Withdrawal symptoms versus drug effects ? Severity of withdrawal manifestations ? Continuing drug exposure from postnatal

treatment

? Type of drug, duration of postnatal treatment

? Family, environmental factors

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