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）：在过去十年中，美国阿片类止痛药 (OPR) 的销量和不良事件增加了四倍。 OPR 的使用和滥用日益增多，影响到广泛的人群，包括孕妇。随着子宫内阿片类药物暴露的增加，新生儿戒断综合征（NAS）的发生率急剧增加，例如在美国，每小时就有一名婴儿出生时出现阿片类药物戒断迹象。到 2009 年，超过 13,500 名婴儿出生时患有 NAS，估计全国医疗保健支出达 7.2 亿美元。田纳西州的 OPR 处方数量在全国排名第二，NAS 比率的增长速度是全国平均水平的三倍。尽管 NAS 迅速增加，但对其根本原因知之甚少，导致所有阿片类药物暴露婴儿的医疗保健利用效率低下。迫切需要研究重点了解与发生 NAS 相关的因素，包括多种药物滥用、精神药物的共同处方和 OPR 处方模式。这项研究将为通过改变母亲和处方者的行为以及通过限制对不会发展为 NAS 的阿片类药物暴露婴儿进行不必要的医院观察来更有效地利用医疗资源来实现 NAS 一级预防的努力提供信息。该项目旨在：1) 使用田纳西州医疗补助计划中大量婴儿的生命统计、管理数据、门诊药房数据、全州医疗记录审查和药物筛选数据来确定 NAS 的预测因素，2) 确定产前阿片类药物处方模式是否有效与 NAS 相关，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，包括生命统计、门诊药房数据、医院管理数据和全州医疗记录审查。总共将从超过 100,000 名孕妇和超过 1,000 名被诊断患有 NAS 的婴儿获得数据。这一系列项目的结果将填补药物滥用、成瘾和 NAS 文献中现有的空白，这些文献将被迅速传播，为临床医生和政策制定者提供信息。这种指导性职业发展经验的总体目标是让候选人成为一名独立的临床研究者，领导一个多学科研究项目，以改善接触物质的婴儿的护理和结果。为了实现这一目标，候选人将通过预测模型、药物流行病学、领导力培训和侧重于妊娠和母婴公共卫生系统物质依赖治疗的实践经验方面的高级课程和实践技能发展来增强其先前的研究培训。在整个颁奖期间，候选人将与多学科导师和顾问团队密切合作，其中包括儿科、妇产科、生物统计学、精神病学、新生儿学、 重症监护医学、公共卫生和流行病学——以实现他既定的职业目标和具体目标。