Neonatal Abstinence Syndrome: Risk of Drug Withdrawal in Opioid-Exposed Infants

新生儿戒断综合症：阿片类药物暴露婴儿的戒断风险

• 批准号: 9250249
• 负责人: Stephen W Patrick
• 金额: $ 13.07万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9250249
• 关键词: ARHGEF5 gene; Academy; Accounting; Address; Adverse event; Affect; American; Analgesics; Assessment tool; Award; Behavior; Biometry; Birth; Caring; Clinical Investigator; Clinical Management; Complement; Complex; Critical Care; Data; Dependency; Development; Diagnosis; Discipline of obstetrics; Dose; Drug abuse; Drug usage; Enrollment; Epidemiologic Studies; Epidemiology; Exhibits; Expenditure; Foundations; Future; Goals; Gynecology; Health; Health Services Research; Health care facility; Health system; Healthcare; Hospital Charges; Hospitalization; Hospitals; Hour; Incidence; Individual; Infant; Infant Care; Insurance Carriers; Interdisciplinary Study; Knowledge; Leadership; Life; Link; Literature; Maintenance Therapy; Medicaid; Medical Records; Medicine; Mentors; Mothers; National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institute of Child Health and Human Development; Neonatal Abstinence Syndrome; Neonatology; Opioid; Outcome; Outpatients; Overdose; Pattern; Pediatrics; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Physicians; Population; Preclinical Drug Evaluation; Pregnancy; Pregnant Women; Primary Prevention; Prospective Studies; Provider; Psychiatry; Public Health; Research; Research Training; Resources; Risk; Risk Assessment; Risk Factors; Sales; Seizures; Series; Skills Development; Substance Withdrawal Syndrome; Substance abuse problem; Syndrome; Tennessee; Time; Tobacco use; Training; United States; Vital Statistics; Work; Writing; addiction; career; career development; drug withdrawal; experience; health care service utilization; high risk; improved; improved outcome; in utero; interest; multidisciplinary; opioid abuse; opioid misuse; opioid use; polysubstance abuse; population based; predictive modeling; prescription opioid; prescription pain reliever; programs; response; skill acquisition; tool

DESCRIPTION (provided by applicant): Over the last decade, sales and adverse events due to opioid pain relievers (OPRs) in the US have quadrupled. The increasing use and abuse of OPRs impacts a wide range of the population, including pregnant women. Concomitant with increased in utero opioid exposures, there has been a dramatic increase in the incidence of neonatal abstinence syndrome (NAS), such that in the US, one infant is born every hour with signs of drug withdrawal from opioids. By 2009, more than 13,500 infants were born with NAS accounting for an estimated $720 million in healthcare expenditures nationwide. The state of Tennessee ranks second in the nation in number of prescriptions written for OPRs and rates of NAS have grown three times faster than the national average. Despite the rapid increase in NAS, underlying causes are poorly understood, resulting in inefficient use of healthcare utilization for all opioid-exposed infants. There is a critical need for research focused on understanding factors associated with developing NAS, including poly-substance abuse, co- prescribing of psychotropic medications and OPR prescription patterns. This research will inform efforts aimed at primary prevention of the NAS through modifying maternal and prescriber behaviors and more efficient use of healthcare resources through limiting unnecessary hospital observation of opioid-exposed infants who will not develop NAS. This project aims to: 1) determine predictors of NAS using vital statistics, administrative data, outpatient pharmacy data, statewide medical record review and drug screen data in a large population of infants in the Tennessee Medicaid Program, 2) determine if antenatal opioid prescribing patterns are associated with NAS and 3) develop a risk assessment tool for NAS. This study includes a rich array of data from the Tennessee Medicaid program comprising vital statistics, outpatient pharmacy data, hospital administrative data and statewide medical record review. In total, data will be obtained from more than 100,000 pregnant women and more than 1,000 infants diagnosed with NAS. The result of this series of projects will fill an existing gap i the literature on drug abuse, addiction and NAS that will be rapidly disseminated to inform clinicians and policymakers. The overarching objective of this mentored career development experience is for the candidate to emerge as an independent clinical investigator leading a multidisciplinary research program to improve care and outcomes for substance-exposed infants. To accomplish this goal, the candidate will augment his prior research training with advanced coursework and practical skills development in predictive modeling, pharmaco-epidemiology, leadership training and practical experiences focused on substance dependency treatment in pregnancy and maternal and infant public health systems. Throughout the award period, the candidate will work closely with a multidisciplinary team of mentors and advisors-including experts in pediatrics, obstetrics and gynecology, biostatistics, psychiatry, neonatology, critical care medicine, public health, and epidemiology-to carry out his stated career objectives and specific aims.

描述（由申请人提供）：在过去的十年中，美国因阿片类止痛药（OPR）引起的销售和不良事件已经二倍。 OPR的使用和滥用越来越多影响包括孕妇在内的广泛人口。随着子宫阿片类药物暴露的增加，新生儿禁欲综合征（NAS）的发生率急剧增加，因此，在美国，一个婴儿每小时出生，并从阿片类药物中戒断药物。到2009年，在全国范围内，有13,500多名NAS出生的NAS为7.2亿美元的医疗支出。田纳西州在为OPR编写的处方数量中排名全国第二，NAS的速度比全国平均水平快三倍。尽管NAS迅速增加，但对基本原因的理解很少，导致所有暴露于阿片类药物的婴儿的医疗保健利用效率低下。迫切需要研究研究与开发NAS相关的因素，包括滥用多种物质，对精神药物的处方和OPR处方模式。这项研究将通过修改母体和处方者行为以及更有效地利用医疗保健资源来为旨在预防NA的努力提供依据，通过限制对不会发展NAS的阿片类药物暴露的婴儿的不必要的医院观察。该项目的目的是：1）使用重要统计数据，行政数据，门诊药房数据，全州医疗记录审查和田纳西州医疗补助计划中大量婴儿的药物筛查数据确定NAS的预测因素，2）确定NAS产前阿片类药物处方模式是否与NAS相关联和3）开发NAS风险评估工具。这项研究包括来自田纳西州医疗补助计划的丰富数据，其中包括重要的统计数据，门诊药房数据，医院管理数据和全州医疗记录审查。总共将从100,000多名孕妇和1,000多名被诊断为NAS的婴儿那里获得数据。这一系列项目的结果将填补现有的关于滥用药物，成瘾和NA的文献，这些文献将迅速传播，以告知临床医生和政策制定者。这种指导的职业发展经验的总体目标是候选人成为一名独立的临床研究者，领导了一项多学科研究计划，以改善暴露于物质的婴儿的护理和结果。为了实现这一目标，候选人将通过高级课程和实践技能开发在预测性建模，药物 - 流行病学，领导力培训和实践经验中，以提高他的先前研究培训，这些培训专注于妊娠以及孕产妇和婴儿公共卫生系统中的物质依赖治疗。在整个奖励期间，候选人将与多学科的导师和顾问团队紧密合作，包括儿科，妇产科，生物统计学，精神病学，新生儿学，新生儿学专家， 重症监护医学，公共卫生和流行病学实现了他既定的职业目标和具体目标。