S W Patrick1, H C Kaplan2, M Passarella3, M M Davis4, S A Lorch5. 1. 1] Department of Pediatrics, Vanderbilt University, Nashville, TN, USA [2] Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, TN, USA [3] Vanderbilt Center for Health Services Research, Nashville, TN, USA. 2. 1] Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA [2] James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 3. Center for Outcomes Research, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4. 1] Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA [2] Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA [3] Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 5. 1] Center for Outcomes Research, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [2] Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [3] Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
OBJECTIVE: Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome experienced by opioid-exposed infants. There is no standard treatment for NAS and surveys suggest wide variation in pharmacotherapy for NAS. Our objective was to determine whether different pharmacotherapies for NAS are associated with differences in outcomes and to determine whether pharmacotherapy and outcome vary by hospital. STUDY DESIGN: We used the Pediatric Health Information System Database from 2004 to 2011 to identify a cohort of infants with NAS requiring pharmacotherapy. Mixed effects hierarchical negative binomial models evaluated the association between pharmacotherapy and hospital with length of stay (LOS), length of treatment (LOT) and hospital charges, after adjusting for socioeconomic variables and comorbid clinical conditions. RESULT: Our cohort included 1424 infants with NAS from 14 children's hospitals. Among hospitals in our sample, six used morphine, six used methadone and two used phenobarbital as primary initial treatment for NAS. In multivariate analysis, when compared with NAS patients initially treated with morphine, infants treated with methadone had shorter LOT (incidence rate ratio (IRR) = 0.55; P < 0.0001) and LOS (IRR = 0.60; P < 0.0001). Phenobarbital as a second-line agent was associated with increased LOT (IRR = 2.09; P<0.0001), LOS (IRR = 1.78; P < 0.0001) and higher hospital charges (IRR = 1.84; P < 0.0001). After controlling for case-mix, hospitals varied in LOT, LOS and hospital charges. CONCLUSION: We found variation in hospital in treatment for NAS among major US children's hospitals. In analyses controlling for possible confounders, methadone as initial treatment was associated with reduced LOT and hospital stay.
OBJECTIVE:Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome experienced by opioid-exposed infants. There is no standard treatment for NAS and surveys suggest wide variation in pharmacotherapy for NAS. Our objective was to determine whether different pharmacotherapies for NAS are associated with differences in outcomes and to determine whether pharmacotherapy and outcome vary by hospital. STUDY DESIGN: We used the Pediatric Health Information System Database from 2004 to 2011 to identify a cohort of infants with NAS requiring pharmacotherapy. Mixed effects hierarchical negative binomial models evaluated the association between pharmacotherapy and hospital with length of stay (LOS), length of treatment (LOT) and hospital charges, after adjusting for socioeconomic variables and comorbid clinical conditions. RESULT: Our cohort included 1424 infants with NAS from 14 children's hospitals. Among hospitals in our sample, six used morphine, six used methadone and two used phenobarbital as primary initial treatment for NAS. In multivariate analysis, when compared with NAS patients initially treated with morphine, infants treated with methadone had shorter LOT (incidence rate ratio (IRR) = 0.55; P < 0.0001) and LOS (IRR = 0.60; P < 0.0001). Phenobarbital as a second-line agent was associated with increased LOT (IRR = 2.09; P<0.0001), LOS (IRR = 1.78; P < 0.0001) and higher hospital charges (IRR = 1.84; P < 0.0001). After controlling for case-mix, hospitals varied in LOT, LOS and hospital charges. CONCLUSION: We found variation in hospital in treatment for NAS among major US children's hospitals. In analyses controlling for possible confounders, methadone as initial treatment was associated with reduced LOT and hospital stay.
Authors: Richard A Epstein; William V Bobo; Peter R Martin; James A Morrow; Wei Wang; Rameela Chandrasekhar; William O Cooper Journal: Ann Epidemiol Date: 2013-08 Impact factor: 3.797
Authors: Feng Yang; Xianping Tong; D Gail McCarver; Ronald N Hines; Daniel A Beard Journal: J Pharmacokinet Pharmacodyn Date: 2006-06-07 Impact factor: 2.745
Authors: Michael R Stenger; Jonathan L Slaughter; Kelly Kelleher; Edward G Shepherd; Mark A Klebanoff; Patricia Reagan; Leif D Nelin; William Gardner Journal: Pediatrics Date: 2012-03-12 Impact factor: 7.124
Authors: Hendrée E Jones; Karol Kaltenbach; Sarah H Heil; Susan M Stine; Mara G Coyle; Amelia M Arria; Kevin E O'Grady; Peter Selby; Peter R Martin; Gabriele Fischer Journal: N Engl J Med Date: 2010-12-09 Impact factor: 91.245
Authors: Stephen W Patrick; Robert E Schumacher; Brian D Benneyworth; Elizabeth E Krans; Jennifer M McAllister; Matthew M Davis Journal: JAMA Date: 2012-04-30 Impact factor: 56.272
Authors: Heather C Kaplan; Meredith E Tabangin; Diana McClendon; Jareen Meinzen-Derr; Peter A Margolis; Edward F Donovan Journal: Pediatrics Date: 2010-07-05 Impact factor: 7.124
Authors: Ciaran S Phibbs; Laurence C Baker; Aaron B Caughey; Beate Danielsen; Susan K Schmitt; Roderic H Phibbs Journal: N Engl J Med Date: 2007-05-24 Impact factor: 91.245
Authors: Faouzi I Maalouf; William O Cooper; Shannon M Stratton; Judith A Dudley; Jean Ko; Anamika Banerji; Stephen W Patrick Journal: Pediatrics Date: 2018-12-04 Impact factor: 7.124
Authors: Jason N Moore; Marc R Gastonguay; Chee M Ng; Susan C Adeniyi-Jones; David E Moody; Wenfang B Fang; Michelle E Ehrlich; Walter K Kraft Journal: Clin Pharmacol Ther Date: 2018-04-28 Impact factor: 6.875
Authors: Stephen W Patrick; Robert E Schumacher; Jeffrey D Horbar; Madge E Buus-Frank; Erika M Edwards; Kate A Morrow; Karla R Ferrelli; Alan P Picarillo; Munish Gupta; Roger F Soll Journal: Pediatrics Date: 2016-04-15 Impact factor: 7.124
Authors: Stephen W Patrick; Judith Dudley; Peter R Martin; Frank E Harrell; Michael D Warren; Katherine E Hartmann; E Wesley Ely; Carlos G Grijalva; William O Cooper Journal: Pediatrics Date: 2015-04-13 Impact factor: 7.124
Authors: Jason R Wiles; Barbara Isemann; Tomoyuki Mizuno; Meredith E Tabangin; Laura P Ward; Henry Akinbi; Alexander A Vinks Journal: J Pediatr Date: 2015-09-11 Impact factor: 4.406