1. Children with a history of neonatal abstinence syndrome (NAS) had higher odds of qualifying for and receiving therapies and services for educational disabilities compared to similar peers without a history of NAS.
2. Classroom therapies or services for developmental delay and speech or language impairment were significantly more common in children with a history of NAS.
Evidence Rating Level: 2 (Good)
Study Rundown: NAS is a growing problem in the United States in the setting of the ongoing opioid epidemic. Previous studies have linked intrauterine opioid exposure to neurodevelopmental problems, but less is known about the quantifiable effect of these problems on children and families. In this retrospective cohort study, researchers linked claims data from Tennessee Medicaid with special education data from the Tennessee Department of Education to compare children with a history of NAS to children with no history of NAS on special education outcomes. Having a history of NAS was associated with higher odds of referral for evaluation of a possible educational disability, eligibility of services, and receiving therapies or services for educational disability. In particular, a greater proportion of children with a history of NAS were eligible for services related to developmental delay or speech or language impairment. These differences persisted when controlling for multiple demographic and health factors.
These findings are limited because other state educational systems may differ from the single state studied. Furthermore, researchers were unable to stratify results based on NAS severity or type of causative substance. Nonetheless, the study is strengthened by its large matched sample that encompassed nearly all cases of NAS in one state. For physicians, these findings highlight the importance of identifying and treating substance use during pregnancy and arranging for early educational interventions in children with a history of NAS.
Relevant reading: Neonatal Abstinence Syndrome and Associated Health Care Expenditures
In-Depth [retrospective cohort]: Researchers linked data from Tennessee Medicaid to Tennessee Department of Education special education data to identify 1815 children born between 2008 and 2011 with a history of NAS. These children were then matched to 5441 children with no history of NAS born in the same period based on sex, race/ethnicity, Medicaid enrollment status, age, and region of residence. The prevalence of special education outcomes in these 2 groups was compared. Results indicated that children with a history of NAS had significantly higher odds of being referred for evaluation of a possible educational disability than children without a history of NAS (adjusted odds ratio [aOR]: 1.44; 95% confidence interval [CI]: 1.23-1.67). They also had higher odds of being eligible for services (aOR: 1.36; 95% CI: 1.15-1.60), particularly due to developmental delay and speech or language impairment, and of receiving therapies or services (aOR: 1.37; 95% CI: 1.16-1.61). These differences persisted in multivariable analysis controlling for maternal tobacco use, maternal education status, birth weight, gestational age, and neonatal intensive care unit (NICU) admission.
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