Title: Mental Disorders Among Children Born With Neonatal Abstinence Syndrome
Abstract: Back to table of contents Previous article Next article DatapointsFull AccessMental Disorders Among Children Born With Neonatal Abstinence SyndromeLaura J. Sherman, Ph.D., Mir M. Ali, Ph.D., Ryan Mutter, Ph.D., Justine Larson, M.D., M.P.H.Laura J. ShermanSearch for more papers by this author, Ph.D., Mir M. AliSearch for more papers by this author, Ph.D., Ryan MutterSearch for more papers by this author, Ph.D., Justine LarsonSearch for more papers by this author, M.D., M.P.H.Published Online:20 Nov 2018https://doi.org/10.1176/appi.ps.201800341AboutSectionsView articleSupplemental MaterialPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleDespite high incidence of neonatal abstinence syndrome (NAS) (1), a drug withdrawal condition resulting from in utero opioid exposure, there are limited longitudinal data regarding children’s outcomes (2). This study extends previous work by examining psychiatric outcomes in early childhood for a sample of Medicaid-covered infants with NAS compared with all other births.Using claims from Truven Health Analytics’ Multi-State Medicaid Database, we used ICD-9 codes to identify infant livebirth (codes V30-V39) records from January 2008 through September 2010 with 5 years of continuous enrollment and a diagnosis of NAS (code 779.5, N=1,046) and all other births (N=269,726) [see online supplement]. Outcomes were mental disorders diagnosed between ages 1 and 5 years (Chapter V codes, 290–319).Approximately half of the children with NAS had a diagnosed mental disorder before age 5, compared with 30% of all other births (p<.05) (Table 1). Compared with all other births, children born with NAS were over twice as likely to have disturbance of conduct, hyperkinetic syndrome of childhood, adjustment reaction, and intellectual disabilities and were over 1.5 times more likely have specific delays in development and other disorders.TABLE 1. Mental disorders among children born with NAS and all other birthsaNAS births (N=1,046)All other births (N=269,726)ICD-9 diagnostic category and code groupN%N%Z scoreAny mental disorder51148.981,81430.312.996*Specific delays in development (e.g., language, coordination) (315)32731.349,59118.410.719*Disturbance of conduct (312)11310.810,8794.011.073*Hyperkinetic syndrome of childhood (e.g., ADHD) (314)949.09,3723.59.687*Adjustment reaction (309)757.27,7992.98.220*Acute reaction to stress (308)494.78,1233.03.156*Neurotic disorders (e.g., anxiety) (300)434.17,3652.72.731*Special symptoms or syndromes (307)413.99,6723.6.579Disturbance of emotions specific to childhood and adolescence (313)393.75,3502.04.033*Intellectual disabilities (317–319)373.54,0741.55.351*Psychoses with origin specific to childhood (e.g., autism spectrum, pervasive developmental disorders) (299)323.14,7521.83.179*aDiagnoses may co-occur. Prevalence of all other diagnostic code groups less than 1%. Source: Truven Health Analytics’ Multi-State Medicaid Database.*p<0.05TABLE 1. Mental disorders among children born with NAS and all other birthsaEnlarge tableThese findings demonstrate that NAS is a marker for high levels of risk of psychiatric conditions in early childhood. Because of environmental and other confounders, we are able to note only an association between NAS and mental disorders, not a causal relationship. Type of opiate or other substance exposure in utero and postnatal treatment likely contributed to the outcomes as well.Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.Send correspondence to Dr. Sherman ([email protected]).The authors report no financial relationships with commercial interests.The authors thank the Assistant Secretary for Mental Health and Substance Use, Elinore McCance-Katz, for her support.References1 Winkelman TNA, Villapiano N, Kozhimannil KB, et al.: Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004–2014. Pediatrics 2018;141:e20173520Crossref, Medline, Google Scholar2 Reddy UM, Davis JM, Ren Z, et al: Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol 2017; 130:10–28Google Scholar FiguresReferencesCited byDetailsCited byWhat’s in a name? The ethical implications and opportunities in diagnosing an infant with neonatal abstinence syndrome (NAS)9 September 2022 | Addiction, Vol. 118, No. 1Behavioral Outcomes of Children With In-Utero Opioid Exposure Age 2-7 and Parenting Self-Efficacy7 December 2022 | Journal of the American Psychiatric Nurses AssociationThe immediate and long-term effects of prenatal opioid exposure7 November 2022 | Frontiers in Pediatrics, Vol. 10Outcomes of Babies with Opioid Exposure (OBOE): protocol of a prospective longitudinal cohort study30 August 2022 | Pediatric Research, Vol. 123Environmental Enrichment Mitigates the Long-Lasting Sequelae of Perinatal Fentanyl Exposure in Mice24 March 2022 | The Journal of Neuroscience, Vol. 42, No. 17Clinical and basic research investigations into the long‐term effects of prenatal opioid exposure on brain development27 May 2020 | Journal of Neuroscience Research, Vol. 100, No. 1Longitudinal Health Care Utilization of Medicaid-Insured Children with a History of Neonatal Abstinence SyndromeThe Journal of Pediatrics, Vol. 233Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysisThe Journal of Pediatrics, Vol. 226Neonatal Abstinence Syndrome and Childhood Mental Health Conditions, 2009–2015: Commercial Versus Medicaid PopulationsKailyn L. Conner, M.P.H., Amy L. Meadows, M.D., M.H.S., Chris Delcher, Ph.D., Jeffery C. Talbert, Ph.D.16 October 2019 | Psychiatric Services, Vol. 71, No. 2Cognitive and Behavioral Impact on Children Exposed to Opioids During Pregnancy1 August 2019 | Pediatrics, Vol. 144, No. 2Foster care admissions and state-level criminal justice-focused prenatal substance use policiesChildren and Youth Services Review, Vol. 102Polysubstance use among reproductive-aged parenting women who misused prescription opioids in the United States24 June 2019 | Journal of Addictive Diseases, Vol. 37, No. 3-4 Volume 70Issue 2 February 01, 2019Pages 151-151 Metrics KeywordsChild psychiatry/developmentalNeonatal Abstinence SyndromeThe authors thank the Assistant Secretary for Mental Health and Substance Use, Elinore McCance-Katz, for her support.PDF download History Received 17 July 2018 Accepted 24 August 2018 Published online 20 November 2018 Published in print 1 February 2019