Pediatric Primary Care Diagnoses Among Children with Intrauterine Opioid Exposure

Abstract

Background and objectives: Characterizing common concerns for children with intrauterine opioid exposure (IOE) can inform tailored primary care.

Methods: Retrospective analysis of primary care data of children with IOE from birth to age two years within one multi-state pediatric health system. Well child care (WCC) and problem-based visit diagnoses were categorized, and descriptive statistics were tabulated.

Results: Three hundred and eighty-five (385) children with IOE had 3,622 primary care visits, of which 51.4% were WCC and 48.6% were problem-based. Most frequent visit diagnoses were upper respiratory complaints (14.8% of visits), feeding difficulties (12.2%), and perinatal viral exposure (9.8%). Although visit type (WCC vs. problem-based) varied across diagnostic category, frequent utilization of both visit types were documented for several diagnoses in infancy (e.g., fussiness/colic, feeding difficulties).

Conclusions: Well child care visits for children with IOE are key opportunities for anticipatory guidance with an emphasis on problems that may contribute to acute health care utilization, particularly in early infancy.

Figure 1:

The 20 most common diagnostic categories by actual number of visits. Percentages represent the percent of unique visits during which a complaint in that category was documented.

Figure 2:

Depicts smoothed density plots of WCC (dashed line) and problem-based (grey fill) visits over the first two-years of life. X axis depicts age in months, Y axis depicts Epanechnikov kernel density estimates of visits.

Figure 3:

Percent of WCC vs. problem-based visits by diagnostic category. Grey bars depict percentage of visits that were WCC, black bars depict percentage of visits that were problem-based. Numbers above each bar indicate the actual number of visits.

Figure 4:

Density plots of problem-based visits for diagnoses documented with similar frequency at both visit types. X axis depicts age in months, Y axis depicts Epanechnikov kernel density estimates of visits. Plots shown are (A) abnormal weight gain (dark grey), other oral concerns (dashed line), and other eye concerns (light grey) and (B) fussiness/colic (dark grey), feeding difficulties (dashed line), and diaper dermatitis (light grey).