Primary care follow-up among children born with neonatal abstinence syndrome in a rural region in the United States

Abstract

Introduction Children born with neonatal abstinence syndrome (NAS) have lower rates of preventive care utilization than children born without NAS, a pattern which is only partially explained by differences in social determinants of health (SDH). We sought to determine whether SDH and clinical characteristics were associated with well-child visit (WCV) attendance among children born with NAS in a rural academic health system. Methods Infants born at a single hospital in 2016–2018 were retrospectively included if they were diagnosed with non-iatrogenic NAS attributable to in utero opioid exposure and established care with an affiliated primary care clinic by 6 months of age. Healthcare utilization was tracked through the first 12 months of life. Independent variables included demographics, prenatal risk factors, insurance coverage, and SDH such as housing problems and food insecurity. Ages and Stages Questionnaire (ASQ) scores were extracted from the latest completed WCV during the first year of life. Results We identified 182 patients with NAS, of whom 80 established care with the primary care clinic, with a median of four WCVs (interquartile range: 2, 5) completed by 12 months of age. On unadjusted Poisson regression, none of the demographic, clinical, or SDH characteristics were associated with the number of completed WCVs. Among 44 patients with available ASQ data, the number of WCVs was not associated with ASQ scores at the latest WCV. Conclusions Within an academic rural health system, SDH and other infant or family characteristics did not predict WCV attendance among infants with NAS.