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Prenatal Substance Exposure and Infant Discharge Placement: Results From the ACT NOW Study

Tre D Gissandaner1, Jordan A Gette2, Kristin J Perry3,4

  • 1Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.

Child Maltreatment
|October 7, 2024
PubMed

Insights

Infants exposed to substances during pregnancy, especially poly-substance use, face a higher risk of out-of-home placement. Withdrawal severity also impacts discharge decisions for these vulnerable infants.

Area of Science:

  • Pediatrics
  • Neonatal Care
  • Public Health

Background:

  • Identifying infants at risk for out-of-home placement is crucial.
  • Prenatal substance exposure and demographic factors influence placement decisions.

Purpose of the Study:

  • To examine factors associated with out-of-home placement for infants with prenatal substance exposure.
  • To identify specific substance exposure patterns and withdrawal severity linked to placement outcomes.

Main Methods:

  • Utilized a validated medical record data extraction tool on data from the ACT NOW study (N=30 sites).
  • Analyzed data from 1808 birthing parent-infant dyads with documented Neonatal Opioid Withdrawal Syndrome (NOWS) scoring or prenatal opioid exposure.
  • Employed latent class analysis to identify substance use patterns and their association with discharge destinations.

Main Results:

  • Infants with prenatal exposure to alcohol, cocaine, meth/amphetamine, and opioids had lower probabilities of discharge to parents.
  • Latent class analysis revealed distinct substance use classes associated with varying discharge probabilities.
  • Less than half of infants in the Poly-use and Meth/amphetamine classes were discharged to parents (47%-49%).
  • Withdrawal symptom severity influenced placement decisions in Poly-use and Prescription Opioid classes.

Conclusions:

  • Prenatal substance exposure, particularly poly-substance use and meth/amphetamine exposure, significantly reduces the likelihood of infant discharge to parental care.
  • Infant withdrawal severity is a critical factor in placement decisions for specific substance exposure classes.
  • Findings support the need for enhanced support, identification, and safe care plans for substance-exposed infants and their families.

Keywords:
child protective servicesinfantlatent class analysisneonatal abstinence syndromeparentspatient discharge

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