Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. DIanna Inman

Clinical Mentor

Dr. Lisa McGee

Committee Member

Dr. Leslie Scott

Abstract

Background: Neonatal abstinence syndrome (NAS) is the set of signs and symptoms present in a newborn whose mother was addicted to drugs while pregnant. NAS can occur due to sudden withdrawal from several drugs, including opioids, benzodiazepines, methamphetamines, and caffeine. It can cause many different issues in the newborn, including diarrhea, tremors, fever, and seizures. While these specific signs and symptoms are self-limited, research is showing that these children grow in to childhood and adolescence with increased risk of Attention-Deficit/Hyperactivity Disorder (ADHD), autism, motor dysregulation, and other cognitive and behavioral sequelae.

Purpose: The purpose of this project was to establish a correlation between a diagnosis of NAS in infancy and a diagnosis of ADHD later in adolescence. This was a retrospective chart review of a large academic health science center’s electronic health record system that identified children who had a diagnosis of NAS in infancy and then later received a diagnosis of ADHD. The goal of this chart review was to identify the prevalence of ADHD among children who were born addicted to drugs. If this data shows a correlation between the two conditions, it will provide the support to intervene early and to improve outcomes for mothers, infants and families.

Methods: The University of Kentucky Center for Clinical and Transitional Science (CCTS) group extracted data from Sunrise Clinical Manager and Ambulatory Electronic Health Records to identify the samples needed for the study. The primary sample criterion was patients being treated at the University of Kentucky Neonatal Intensive Care Unit for NAS at any time from August 1st, 2008 until August 1st, 2018. ICD 9 and ICD 10 billing codes were then used to search this sample population for children with a diagnosis of ADHD, medication prescription for Guanfacine, Adderall, Ritalin (methylphenidate), and Focalin (dexmethylphenidate), and zip code (first 3 digits). These data points were extracted to see which children with NAS developed ADHD, and where these patients lived.

Results: 1432 patients were identified from the electronic health records as having NAS during the requested time range. Of these patients, 22 (1.5%) had a subsequent diagnosis of ADHD, and 31 (2.1%) had subsequent pharmacologic treatment with one or more of the ADHD medications. Only 157 (10.9%) of the patients live in Fayette County, and 329 (22.9%) live in a neighboring county. Nine hundred and forty six (66%) of the patients live further than two counties away from Fayette County.

Conclusion: Current research shows a 30-60% correlation between NAS and subsequent development of ADHD, which is much higher than the data present in this study. Many patients with NAS that are treated at the University of Kentucky NICU are transferred from outside hospitals and live far away from Lexington, in areas where traveling to the University for primary care may not be feasible. If the patient doesn’t return to a University of Kentucky outpatient clinic then they were not captured in the ADHD data, regardless if they suffered from the condition or not. Many of the patients with NAS (up to 88.9% of them) live in Eastern Kentucky and may not be included in the ADHD portion of the data. As a result, patient education programs on the short-term and long-term effects of NAS, including the risk of ADHD and other developmental disorders, and early intervention services for children and families may be more effective in the counties where the patient and families reside.

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