Abstract
The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children. A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool. This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitates healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population. This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for NAS infants. NAS infants tend to have decreased access to and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.
Highlights
Neonatal abstinence syndrome (NAS) is a significant public health problem in the USA and abroad
The primary research objective was to answer the question: Do NAS infants have poorer utilization of healthcare following discharge compared with non-NAS infants? The primary outcome for healthcare utilization was derived from data reporting hospital readmission, emergency room (ER) visits, and metrics regarding ambulatory specialty or primary care clinic utilization
The specific inclusion criteria included: (1) peer-reviewed articles reporting on broad aspects of healthcare utilization in NAS children, (2) articles reporting sociodemographic data of NAS children, and (3) articles with a pediatric population (< 18 years of age)
Summary
Neonatal abstinence syndrome (NAS) is a significant public health problem in the USA and abroad. The majority of published literature on the subject focuses on prenatal prevention, postnatal diagnosis, and effective treatment strategies during the birth hospitalization to better identify and safely treat these neonates. Successful substance treatment and weaning strategies are critical issues with this vulnerable population during birth hospitalization and immediately following discharge; these infants are at risk of having other health conditions being dismissed or delayed in the outpatient setting. The complex interconnected medical problems that these children face requires multidisciplinary care. While there is evidence of long-term complications of NAS a variety of health conditions, limited research has explored the barriers and facilitators to outpatient healthcare access and utilization for these children following discharge from the hospital [5]
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