Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome.
Elizabeth Peacock-Chambers, JoAnna K Leyenaar, Sheila Foss and 5 others
PMID 31107767WHAT IT FOUND
Among 256 infants with neonatal abstinence syndrome, 77% were referred to early intervention, about half enrolled, and 38% stayed enrolled over 6 months.
Referral was higher when infants went home with a biological parent.
Key findings
0177% of infants were referred to early intervention, about half enrolled, and 38% sustained enrollment for longer than 6 months.
02Infants discharged to biological parents were referred 81% of the time, versus 66% of infants discharged to foster parents, and biological-parent discharge was associated with an adjusted odds ratio of 2.30 for referral.
03Infants in the top hospital-stay tertile had 2.70 times the odds of early intervention enrollment compared with the first tertile, and each additional week of stay was associated with 19% increased odds.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study was done at one tertiary hospital in Massachusetts with state-specific early intervention eligibility and hospital referral practices, so the referral and enrollment rates may not apply elsewhere. It was a retrospective chart review, so information could be missing or misclassified, especially from diagnostic codes. Infants born before 35 weeks gestational age or with chromosomal anomalies were excluded, so the paper does not describe those infants. The referral difference between biological and foster parents may be explained by different referral pathways: hospital case managers referred infants to biological parents, while child protective services referred infants in foster care. The confidence interval for the biological-parent referral odds ratio was wide, so the estimate is imprecise. Many factors that could influence voluntary enrollment, such as family beliefs, home environment, maternal relapse, education, socioeconomic status, housing stability, and social support, were not measured. Length of stay may be a marker of NAS severity or perceived need rather than a cause of enrollment.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not assume that infants with NAS automatically receive early intervention services. Only about half enrolled, and 77% were referred, so referral did not guarantee enrollment.