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Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Peacock-Chambers, Elizabeth MD, MS*,†; Leyenaar, JoAnna K. MD, MPH; Foss, Sheila RN*; Feinberg, Emily ScD, CPNP§; Wilson, Donna MS; Friedmann, Peter D. MD, MPH; Visintainer, Paul PhD; Singh, Rachana MD, MS*

Journal of Developmental & Behavioral Pediatrics: July/August 2019 - Volume 40 - Issue 6 - p 441–450
doi: 10.1097/DBP.0000000000000679
Original Article

Objective: To identify factors associated with referral and enrollment in early intervention (EI) for infants with neonatal abstinence syndrome (NAS).

Methods: We conducted a retrospective cohort study of 256 infants born with NAS (2006–2013) at a tertiary care hospital in (Springfield), Massachusetts, linking maternal-infant birth hospitalization records with Department of Public Health EI records. We calculated the percent of infants retained at each step in the EI enrollment process over the first 3 years of life. We conducted separate multivariable logistic regression analyses to identify factors associated with EI referral and enrollment.

Results: Among mothers, 82% received medication-assisted treatment at delivery, 36% endorsed illicit drug use during pregnancy, and 76% retained custody of their child at discharge. Among infants, 77% were referred to EI and 48% were enrolled in services. Of infants discharged to biological parents, 81% were referred to EI versus 66% of infants discharged to foster care (p ≤ 0.05); this difference persisted in multivariable analysis [adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09–4.86]. Infants in the highest tertile for length of stay had 2.70 times the odds of EI enrollment (95% CI, 1.37–5.31).

Conclusion: Fewer than half of the eligible infants with NAS were enrolled in EI services. Discharge to a biological parent and longer hospital stay had the strongest associations with EI referral and enrollment, respectively. Efforts to improve EI referral rates during the birth hospitalization, particularly among infants discharged into foster care, and close follow-up for infants with shorter hospital stays would enhance the developmental supports for this vulnerable population.

*Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA;

Institute for Healthcare Delivery and Population Science, UMMS-Baystate, Springfield, MA;

Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH;

§Department of Pediatrics, Boston University School of Medicine, Boston, MA;

Department of Medicine, Office of Research, UMMS-Baystate, Springfield, MA.

Address for reprints: Elizabeth Peacock-Chambers, MD, Department of Pediatrics, UMMS-Baystate, 3601 Main St, Floor 3, Springfield, MA 01199; e-mail:

This study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), Award Number 1KL2TR002545. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Disclosure: The authors declare no conflict of interest.

Received July 17, 2018

Accepted March 12, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.