Home Visitation Programs for Pregnant Women in Rural West Virginia

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Table of Contents

Introduction
History of NAS
Impact of NAS on Health Care System
Demographic Information Relative to Aggregate
Relevant Research
Conclusion
References

Introduction

Neonatal Abstinence Syndrome is a cluster of complications that affect the functioning of the neonate’s central nervous, respiratory, and digestive systems spurred on by drug withdrawal after birth. Although different drug exposures have been associated with NAS diagnoses, in-utero opioid exposure has been identified as the primary common cause of neonatal withdrawal (Mathis et al., 2018). Therefore, newborns exposed to alcohol and other neuropsychiatric medications during pregnancy stand the highest chance of suffering from NAS. A breakdown of the history of this disorder, its impact on the healthcare system, and a summary of three studies conducted in West Virginia (WV) to address it form the basis of this paper.

History of NAS

In 1875, the first incident of Neonatal Abstinence Syndrome in newborns and its subsequent treatment were reported. By 2009, the prevalence of NAS, previously referred to as Congenital Morphinism, had risen to more than 300 per 10,000 live births (Meagan et al., 2017). This was followed by a corresponding increase in the percentage of newborns receiving pharmaceutical treatment for the condition. The continuous rise in opioid prescriptions and hence use in a state such as West Virginia and Kentucky indicate that a NAS pandemic may develop in the U.S. The section that follows elaborates on how NAS has impacted the healthcare system in West Virginia.

Impact of NAS on Health Care System

NAS has had a significant impact on the entire Health Care System in West Virginia over the years. For instance, the average medical bill associated with delivering a NAS baby surged from $29,450 in 2002 to $48,900 in 2009, with 80.6 % of expenses being met by the state’s Medicaid plan (Meagan et al., 2017, p. 94). Furthermore, neonatal critical care facilities are frequently understaffed to meet the high demands of infants delivered with opioid withdrawal. Despite the knowledge of the adverse health consequences of NAS being publicly available in this state, its prevalence has skyrocketed thus exerting unprecedented pressure on the available healthcare resources. The section below highlights the prevalence of NAS per 1000 live births in West Virginia.

Demographic Information Relative to Aggregate

The state-wide incidence of NAS increased by about 300% between 2000 and 2012, from four to eight per 1000 newborns each year (Stabler et al., 2017). The increased opioid abuse in this state has been directly attributed to this significant surge. Prescriptions for opioid pain relievers quadrupled in the last decade thus explaining the surge in opioid-induced deaths (Stabler et al., 2017). This crisis has insidiously extended to expectant mothers, with two in every ten pregnant women receiving this prescription between 2002 and 2009 across the state.

Relevant Research

Overview of Research (Research Related to Incidence/Prevalence, Screenings, Interventions)

According to research on incidence/prevalence, screenings, and interventions in WV, NAS is generally triggered by antepartum opiate abuse. However, similar cases have been reported in the context of other narcotic prescriptions as well. Between 2002-2005 and 2006-2009, the prevalence of NAS in West Virginia rose by more than double (Stabler et al., 2017). This was after the 2007 nationwide geographic variations in NAS which revealed that the highest rates occurred in the Southern and Eastern regions, with 17.4 cases per 1,000 hospital live births (Stabler et al., 2017). Conversely, research on the detection of prenatal substance use by screening and supportive care interventions has assisted healthcare practitioners in different ways. This is because it allows them to better plan for potential neonatal and obstetric clinical manifestations at birth. Thus, at-risk newborns are recognized for early NAS therapy and a protracted hospital stay is scheduled when necessary.

Particularly Significant Research

Different studies have been done using data from the West Virginia Health Care Authority, Uniform Billing Database, to solve the NAS crisis in West Virginia. The results of interest, which were determined by the existence of ICD-9-CM 779.5 (a drug withdrawal syndrome in neonates) influenced the NAS conventional prevalence statistics per 1,000 live births (Patrick et al., 2018). The data were combined by seven geographical sub-state divisions that the Substance Abuse and Mental Health Services Administration 2009-2011 report had previously identified to comply with the National Health Insurance Act confidentiality protocols.

Summary of Three Significant Research Studies

As already discussed above, different NAS-related cross-sectional studies have been conducted over the years. For instance, in the 2007–2013 study, UBD data for 119,605 infant hospitalizations with 1,974 NAS symptoms were examined (Meagan et al., 2017). Exposure diagnosis codes for opioids and NAS (ICD9-CM 779.5) were useful in identifying prevalence rates. Additionally, to determine the nature and extent of exposure, the ICD-9-CM codes for noxious products affecting newborns were recorded. This diagnosis indicated drug exposure to methamphetamine, psilocybin, and prescription opioid painkillers could easily trigger NAS.

In the second study, Project WATCH teamed with the WV Department of Health and Human Resources to incorporate real-time data on drug use during pregnancy. Convulsions and gastrointestinal complications were jointly assessed and corresponding ICD-9-CM metrics were used to further define the selected cohort (Umer et al., 2018). The third study involved a nonrandomized trial that enrolled 98 expectant mothers who were treated by telemedic therapies and in-person ambulatory care clinics (Guille et al., 2020). Results revealed that between weeks six and eight after delivery, adherence to therapy did not differ significantly across the two groups.

Conclusion

NAS is a series of symptoms that some newborns develop after their mothers’ passive transfer of drug-related components during gestation is stopped. Although the general public is aware of the adverse health consequences associated with NAS, its prevalence has continuously skyrocketed especially in states such as West Virginia thus exerting pressure on the available healthcare resources. Concurrently, efforts made to solve this crisis through different studies in this state cannot be overlooked.

References

Guille, C., Simpson, A. N., Douglas, E., Boyars, L., Cristaldi, K., McElligott, J., Johnson, D., & Brady, K. (2020). Treatment of opioid use disorder in pregnant women via telemedicine. JAMA Network Open, 3(1), e1920177. Web.

Mathis, S. M., Hagemeier, N., Hagaman, A., Dreyzehner, J., & Pack, R. P. (2018). A dissemination and implementation science approach to the epidemic of opioid use disorder in the United States. Current HIV/AIDS Reports, 15(5), 359–370. Web.

Meagan, E., Leann, D., Ilana, R. A., Peter, R., & Laura, R. (2017). Neonatal abstinence syndrome in West Virginia sub-state regions, 2007-2013. Journal of Rural Health, 33(1), 92-101. Web.

Patrick, S. W., Buntin, M. B., Martin, P. R., Scott, T. A., Dupont, W., Richards, M., & Cooper, W. O. (2018). Barriers to accessing treatment for pregnant women with opioid use disorder in Appalachian states. Substance Abuse, 40(3), 356–362. Web.

Stabler, M. E., Long, D. L., Chertok, I. R., Giacobbi Jr, P. R., Pilkerton, C., & Lander, L. R. (2017). Neonatal abstinence syndrome in West Virginia substate regions, 2007‐2013. The Journal of Rural Health, 33(1), 92-101.

Umer, A., Loudin, S., Maxwell, S., Lilly, C., Stabler, M. E., Cottrell, L., Hamilton, C., Breyel, J., Mullins, C., & John, C. (2018). Capturing the statewide incidence of neonatal abstinence syndrome in real-time: The West Virginia experience. Pediatric Research, 85(5), 607–611. Web.

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