Maternal Drug Use and the Severity of Neonatal Abstinence Syndrome

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East Tennessee and Middle Appalachia is the epicenter of the prescription drug epidemic, with approximately 15% of women giving birth at our institution documented as suffering from drug addiction. Objective: In this chapter we describe our sample of women giving birth to infants who were drug exposed and experienced Neonatal Abstinence Syndrome (NAS) and to determine the maternal and neonatal factors associated with the severity of NAS as measured by the length of stay (LOS) in the Neonatal Intensive Care Unit (NICU). Methodology: This was a retrospective chart review of 73 infants diagnosed with NAS and treated in the NICU. We conducted bivariate analyses and multivariate modeling (least squares regression with backward elimination) of the significant variables (p <.10) against the infant’s LOS. Results: The mean LOS for infants with NAS was 17.7 days (sd = 11.6); 75.3% received nonpharmacological and 86.3% received pharmacologic (morphine) treatment. Of 73 women, 53.4% had a history of mental illness; 53.4% smoked >5 cigarettes per day in last trimester; 89% were taking buprenorphine, 9.6% had cord tissue positive for benzodiazepine. Term infants had 2.3 day longer LOS on average (p = 0.027) compared to preterm infants; infants exposed to benzodiazepines had 12.7 day longer LOS on average (p = 0.07) and prenatal exposure to >5 cigarettes per day in last trimester increased the hospital stay by 6.4 days (p = 0.022). Conclusion: We found that exposure to benzodiazepines and cigarette smoking were associated with an increased LOS.

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