Neonatal Abstinence Syndrome An emerging issue for Part

+ Neonatal Abstinence Syndrome: An emerging issue for Part C systems?

+ NAS DEFINITION A drug withdrawal syndrome that presents in newborns after birth when transfer of harmful substances from the mother to the fetus abruptly stops at the time of delivery Most frequently due to opioid use in the mother, but may also be seen in infants exposed to benzodiazepines, and alcohol.

+ NAS Origin Fetal exposure usually occurs for one of three reasons: n 1. Mothers are dependent/addicted to opioids, either prescribed or illicit. n 2. Mothers require prescription opioids for another disease process n 3. Mothers receive methadone therapy to facilitate safe withdrawal from addiction to prescription or illicit opioids.

Opioid Prescriptions n Opioid pain relievers and benzodiazepine sedatives are commonly prescribed in the United States. n Overprescribing of opioid pain relievers can result in multiple adverse health outcomes. n Wide variation exists from one state to another n Need for state monitoring of prescribing patterns

+Prescribing Rates per 100 Persons United States 90 80 70 82, 5 60 50 40 37, 6 30 20 10, 3 Opioid pain relievers Long-acting extended release opioid pain relievers 4, 2 High-dose Opioid pain relievers Benzodiazepines

+ Prevalence of Maternal Opioid Use 5, 63 Rate per 1, 000 births/year 6 5 4 3 2 2, 52 1, 19 1, 26 2000 2003 1 0 2006 2009

Prevalence of NAS 7 Rate per 1, 000 births/year + 5, 8 6 5 4 3, 39 3 2 1, 5 1, 96 1 0 2003 2006 2009 2012

+ MEAN HOSPITAL CHARGES NATIONAL COST OF HEALTH CARE FOR INFANTS DIAGNOSED WITH NAS: n 2000: $190 MILLION n 2009: $720 MILLION n During that time frame, hospital stay for newborns shortened but average hospital stay for babies with nas stayed the same.

+ Medical Issues in the Newborn n Fetal Growth n Low birth weight n Growth restriction n Breastfeeding n Alcohol and Tobacco - Benefits may be outweighed by impact of substances n Street Drugs – transmitted through breast milk n Methadone use http: //pediatrics. aappublications. org/content/early/2013/02/20/peds. 2012 -3931

Nicotine Alcohol Marijuana Opiates Cocaine Meth Short Term - Birth Effect Strong Effect No Effect Anomalies No Consensus Strong Effect No Effect Withdrawal No Effect Strong Effect No Data Effect Effect No Consensus Strong Effect No Consensus No Data Behavior Effect Strong Effect No Data Cognition Effect Strong Effect No Consensus Effect No Data Language Effect No Data Achievement Effect Strong Effect No Data No Consensus No Data Fetal Growth Neurobehavior Long Term Effects Growth

+ So what does this mean for infant toddler early intervention C? n New Population n Eligibility Criteria n Mother/Baby Dyad n Family Dynamics n Types of Services n Medical n Provider n Home Involvement Training System Capacity

+ 2015 Tipping Points Question n Thirteen States addressing NAS issue: n Included in eligibility criteria; n At Risk n Established Condition; n Monitor trends and convened a NAS workgroup to discuss system implications; n Clarifying guidance for providers on substance exposed infants and what to consider in the eligibility process.