P3B077: Characteristics and Factors Associated with Discharge Disposition of Neonatal Abstinence Syndrome Infant

Background: Neonatal abstinence syndrome (NAS) has increased with the opioid epidemic. At Berkeley Medical Center (BMC) in WV, NAS infants contributed to 15% of NICU admission. Haarbauer et al observed that infants with NAS from non-prescribed opioids who required medical treatment were discharged with less frequency to their parents. Previous reports indicate improved neurocognitive outcomes in those infants raised by foster parents. The aim of this study is a) to describe characteristics of discharge disposition among NAS infants admitted to BMC NICU from 2015 to 2021 and b) to explore the association between maternal history of illicit drugs, the need for pharmacological treatment, and the discharge disposition.

Methods: This study is a single-center retrospective chart review of infants admitted to the NICU at BMC from 2015 to 2021 with the diagnosis of NAS based on ICD-10. Maternal and neonatal data were collected, including gestational age, sex, birth weight, maternal drug history, discharge disposition, and maternal opioid maintenance program (OMP) status in the mother. Characteristics of the infants discharged with foster families were analyzed and discussed. Also, we strive to assess if there are any factors that play a role in the discharge disposition. Fisher exact test and ANOVA analysis were used in the data analysis.

Results: Our infant cohort (n=200) had a mean GA of 37 weeks and 4 days. The average BW was 2878 grams. We classified discharge disposition into 3 categories: 132(66%) infants were discharged home with the mother (Group 1), 29(14.5%) infants were discharged home under the care of a family member (Group 2) and 39(19.5%) infants were discharged home with a foster family (Group 3). The average length of stay (LOS) is 15.6 days; when compared between group 1 vs group 3, the average LOS is significantly higher in group 3 (14.3 vs 17.7 days; p value < 0.05). In Group 3, 79% (31/39) of the mothers reported a history of illicit drug use such as heroin or cocaine; 66% (26/39) were not enrolled in an OMP; umbilical cord tissue drug screen was positive in 31% (12/39) of the patients; 90% (35/39) had limited or no prenatal care; and 72% (28/39) of the infants required pharmacological treatment with morphine. These factors are independently associated with foster care placement; with a p-value < 0.001.

Conclusion: The majority of NAS infants were discharged to the mother in our cohort. Use of illicit drugs such as heroin or cocaine in mothers, positive UCTDA for those illicit drugs, and requirement of pharmacological treatment associated with discharge disposition to the foster family. LOS which might reflex the need for pharmacological treatment was also a factor for foster placement.