443 - Engagement and adherence with recommended developmental follow-up among infants with intrauterine opioid exposure

Poster Number: 443
Publication Number: 443.121

Margarida Mascarenhas, MassGeneral Hospital for Children, Cambridge, MA, United States; Davida Schiff, Massachusetts General Hospital, Boston, MA, United States; Leslie Kerzner, Harvard Medical School, Boston, MA, United States; Kathryn Dee MacMillan, Brigham and Women's Hospital, Sharon, MA, United States; Leela Sarathy, Mass general hospital, Boston, MA, United States; Megan M. Church, MGH, Boston, MA, United States; suzanne Curley, Boston, CHARLESTOWN, MA, United States

Background: Enhanced developmental monitoring of infants with intrauterine opioid exposure is advised but factors associated with engagement and adherence to developmental follow up (DFU) clinics and early intervention (EI) services are unknown.

Objective: To describe the engagement and adherence of opioid-exposed infants (OEI) to recommended developmental monitoring in the first year of life, through DFU programs and EI services. To identify maternal-, infant- and clinic-level factors associated with engagement.

Design/Methods: We conducted a retrospective cohort study of infant observed or treated for Neonatal Opioid Withdrawal Syndrome (NOWS) at a tertiary care hospital in Massachusetts between 2016-2020, linking birth hospitalization and DFU records with the Department of Public Health EI records. Primary outcomes were at least one visit at DFU clinic and evaluation by EI. We used multivariable logistic regression to identify factors associated with DFU and EI engagement.

Results: Two hundred and seven opioid exposed mother-infant dyads were included. Mothers were mostly Non-Hispanic White (82%), publicly insured (88%), on medication to treat Opioid Use Disorder (MOUD) (76%). Nearly half (49%) the infants were treated pharmacologically for NOWS. A report was filed to child welfare service in 88% of cases, with 77% discharged in parental custody. Fifty six percent of the infants were referred to the DFU program and 24% attended at least one visit. In the total cohort, 69% were referred to EI, 28% completed an intake evaluation and 26% enrolled in services.  Odds of attendance at DFU were higher for infants born to Non-Hispanic White mothers (aOR 5.07,1.24-20.8), treated pharmacologically (aOR 2.51, 1.05-5.99), enrolled in EI (aOR 3.85, 1.48-10.1), cared for in a specialty clinic for families impacted by substance use disorder (aOR 5.22, 1.57-17.3) and with maternal cocaine (aOR 3.2, 1.3-7.88) and marijuana (aOR 2.98, 1.2-7.98) use. Odds of evaluation by EI were higher for infants of female sex (aOR 2.28,1.07-4.85), whose mothers were on MOUD (aOR 4.66, 1.51-14.4) and lower for those who remained in parental custody (aOR 0.19, 0.07-0.5).Conclusion(s): A minority of eligible infants engaged in DFU programs or EI services in the first year of life. Care in a specialty clinic and enrollment in EI had the strongest association with attending the DFU clinic. EI evaluation was most strongly associated with maternal MOUD and parental custody at hospital discharge. Efforts to improve engagement in recommended follow-up should elicit the perspectives of caregivers to understand the mechanisms that drive these differences.
igure 1. Engagement in recommended follow-up services; A: Engagement in Developmental Follow-up (DFU) clinic; B: Engagement in Early Intervention (EI) services
Table 1. Characteristics of the cohort by engagement in recommended developmental follow-up servicesLegend: CI: confidence interval; DFU: developmental follow-up clinic, EI: early intervention; MOUD: medication to treat opioid use disorder; NICU: neonatal intensive care unit; NOWS: neonatal opioid withdrawal; SCN: special care nursery; SD: standard deviation; SSRI: selective serotonin receptor inhibitors