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. 2020 Feb;145(2):e20191275.
doi: 10.1542/peds.2019-1275. Epub 2020 Jan 2.

Well-Child Care Adherence After Intrauterine Opioid Exposure

Neera K Goyal  1 , Jessica F Rohde  2   3 , Vanessa Short  4 , Stephen W Patrick  5 , Diane Abatemarco  4 , Esther K Chung  6
Affiliations

Well-Child Care Adherence After Intrauterine Opioid Exposure

Neera K Goyal et al. Pediatrics. 2020 Feb.

Abstract

Background and objectives: For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population.

Methods: In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15- and 18-month visits. Gaps in WCC, defined as ≥2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status.

Results: Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed (P < .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [P < .001] and 0.74 [P < .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P < .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening.

Conclusions: Children <2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram of sample derivation. The arrow curving outward depicts observations excluded from the analysis. The gray box depicts the final cohort included for analysis.
FIGURE 2
FIGURE 2
WCC visit completion over time. Gray bars represent children with IOE. Black bars represent children without IOE. The y-axis represents the percentage who completed at least 1 WCC visit during each age interval, shown on the x-axis. * P < .05.
FIGURE 3
FIGURE 3
Gaps in WCC visits over time. Gray bars represent children with IOE. Black bars represent children without IOE. The y-axis represents the percentage with ≥2 consecutive missing WCC visits during each age interval, shown on the x-axis. * P < .05.
See this image and copyright information in PMC

References

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