P2.H154: Maternal adherence to a novel pilot prenatal visit program with a neonatology provider is a predictor of neonatal outcome in in-utero opioid-exposed infants.

Background: Fetal opioid exposure may lead to NOWS after birth. At our institution, infants are monitored for five days for signs/symptoms of withdrawal, and if meeting the criteria, they are started on medications to manage symptoms/signs of NOWS. This leads to increased LOS and healthcare costs. The neonatology providers, in collaboration with our Obstetrics department, started a prenatal visit program for mothers with opioid use during pregnancy to provide an overview of the course of their infant after birth, including the LOS of at least five days in the newborn nursery, modified Finnegan scoring for NOWS and course of NOWS. Only a portion of the mothers were successfully contacted to schedule a consultation, and even fewer attended.

Methods: Retrospective cohort study of mother-infant dyads exposed to opioids in-utero in two large urban centers. Current practice is to arrange a prenatal appointment with a neonatology provider between 32 and 34 weeks of gestation. Dyads meeting the following criteria were included: exposure to opioids in-utero, a confirmed scheduled prenatal appointment with a neonatologist, gestational age of 35 weeks or greater at birth, and birth weight >2 kilograms. Exclusion criteria included NICU admission for a primary diagnosis other than NOWS and evaluation for withdrawal from non-opioid medications. The dyads were divided into two groups – Mothers who attended the appointment (Group A) and mothers who did not attend (Group B).

Results: A total of 150 dyads met the study criteria. Maternal enrollment in a opioid substitution program, lower educational attainment, and lower birth weight were significantly associated with failure to complete the prenatal appointment. Non-attendance was associated with higher rates of smoking and alcohol use during pregnancy. The LOS for infants not requiring medication was 5 days, compared to a 22 day average LOS for those requiring medications to treat NOWS. The primary outcome, need for pharmacological treatment in infants for NOWS, was significantly higher in the group where the mother did not attend their appointment (p=0.03, Odds ratio 0.49, 95% Confidence interval 0.26 to 0.95). Maternal adherence to the appointment is associated with a 51% reduction in the chance of the infant being treated with medication after birth. Considering the average daily charge for a stay in the newborn nursery is $1710.5 and $2110.0 for the NICU, the difference between infants requiring medications and those not requiring medications is $37,867.5 per child [$46,420 (22 days of NICU stay) vs. $8552.5 (5 days of newborn nursery stay)].

Conclusion: Mothers using opioids during pregnancy who were compliant with their neonatology appointment are less likely (51% less) to have their infants require medications, which could save a significant amount of healthcare expenditure. Hospitals could utilize this information to divert more resources/follow-ups to mothers who don't attend these prenatal visits.