Trends in infants reported to child welfare with neonatal abstinence syndrome (NAS)
Trends in infants reported to child welfare with neonatal abstinence syndrome (NAS)
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DOI：
10.1016/j.childyouth.2018.01.035
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发表时间：
2018-02-01
影响因子：
3.3
通讯作者：
Mattson, Margaret
中科院分区：
文献类型：
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作者：
Lynch, Sean;Sherman, Laura;Mattson, Margaret
背景：看护者滥用药物是虐待儿童的一个已知风险因素，其中一些儿童随后引起了儿童福利系统的关注。最近的阿片类药物流行导致怀孕期间使用阿片类药物的妇女和出生时患有新生儿戒断综合症（NAS）的婴儿数量不断增加，这引发了一个问题：向儿童福利系统报告的这些婴儿的数量是否随之增加。本研究的目的是检查 2004 年至 2014 年向儿童福利系统报告的患有新生儿戒断综合症 (NAS) 的婴儿数量和百分比的趋势，并确定该趋势是否与报告患有胎儿酒精谱系障碍 (FASD) 的婴儿的百分比趋势不同。 方法：我们分析了国家儿童虐待和忽视数据系统 (NCANDS) 2004 年至 2014 年期间报告患有 NAS 的婴儿（年龄 <1 岁）的数据。 2014 年。由于研究期间各州数据收集和数据质量存在差异，样本包括来自 10 个州的报告。我们利用广义估计方程 (GEE) 模型方法来检查 10 个州样本中向儿童福利部门报告的 NAS 和 FASD 病例百分比随时间的趋势。年份被用作识别变量，物质类型随时间重复并按州进行聚类。结果：10 个州报告的 NAS 婴儿数量最低，2009 年为 3073 例，最高为 2014 年 4806 例。报告的 NAS 病例平均百分比从 2004 年的 4.72% 上升到 2014 年的 9.19%。GEE 的结果显示，物质类型 (p = 0.015) 和年份 (p = 0.009) 的主效应，表明总体而言，跨时间平均，NAS 报告的百分比大于 FASD 报告的百分比，并且跨物质类型平均，与物质相关的报告的百分比随着时间的推移而增加。讨论：NAS 报告随着时间的推移显着增加，在 2010 年至 2014 年期间最为明显，而 FASD 报告的趋势在研究期间没有显示出显着变化期间。此外，儿童福利报告从 10 个州样本中获得的数据与国家 NAS 发病率数据一致。尽管最近已经采取了遏制处方药和其他供应方式的措施，但这些公共卫生举措是否会继续或缓解这种大幅增长，仍有待观察。然而，总体而言，这些发现表明，需要立即努力使儿童福利系统适应这一趋势，并治疗育龄妇女的阿片类药物成瘾。
Background: Substance abuse among caregivers is a known risk factor for child maltreatment, and some of these children subsequently come to the attention of the child welfare system. The recent opioid epidemic has led to rising numbers of women who use opioids during pregnancy and infants born with neonatal abstinence syndrome (NAS), raising the question of whether there has been a consequent rise in the numbers of these infants reported to the child welfare system. The purpose of this study is to examine the trend in the number and percentage of infants reported to the child welfare system with neonatal abstinence syndrome (NAS) from 2004 to 2014, and determine whether the trend is distinct from the trend in the percentage of infants reported with fetal alcohol spectrum disorder (FASD).Methods: We analyzed National Child Abuse & Neglect Data System (NCANDS) data on reports of infants (aged < 1 year) with NAS between 2004 and 2014. Due to state differences in data collection and data quality across the study period, the sample included reports from 10 states. We utilized a Generalized Estimating Equations (GEE) model approach to examine the trend over time in the percentage of NAS and FASD cases reported to child welfare in our 10 state sample. Year was used as an identifying variable and Substance Type was repeated over time and clustered by State.Results: The number of reports of infants with NAS for the 10 states was the lowest at 3073 in 2009 and highest at 4806 in 2014. The average percentage of cases of NAS reported rose from 4.72% in 2004 to 9.19% in 2014. The results of the GEE revealed a significant main effect of Substance Type (p = 0.015) and Year (p = 0.009), indicating that overall, averaged across time, the percentage of NAS reports was greater than the percentage of FASD reports and averaged across substance type, the percentage of substance-related reports increased over time.Discussion: NAS reports increased significantly over time, most pronounced between 2010 and 2014, while the trend for FASD reports did not show significant change over the study period. Moreover, the child welfare reports data obtained from the 10 state sample aligned with national NAS incidence data. Although recent efforts to curb prescribing and other means of supply have been implemented, it remains to be seen whether the large rise seen will continue or be ameliorated by these public health initiatives. However, overall these findings suggest that immediate efforts are needed to prepare the child welfare system for this trend, as well as to treat opioid addiction among women of child bearing age.