Characterization of Babies Discharged from Cabell Huntington Hospital During the Calendar Year 2005 with the Diagnoses of Neonatal Abstinence Syndrome

Recent concern regarding the impact of maternal drug abuse on neonatal well-being was the impetus for this retrospective cohort study of newborns diagnosed with neonatal abstinence syndrome that were discharged from Cabell Huntington Hospital during the calendar year 2005. Medical records of the neonates and their mothers were analyzed for a variety of health related outcomes and healthcare cost. Forty-eight neonates were diagnosed with Neonatal Abstinence Syndrome in 2005, forty of which required NICU assistance. The average maternal age at delivery was 26; gravity was 3.1 and most were single, separated or divorced. The majority had poor or inconsistent prenatal care. Twenty-one delivered by cesarean section most often for fetal distress. Most delivered prematurely with an average gestation of 35.9 weeks. Half of the mothers went into preterm labor with half of those having premature ruptured membranes. Opiates were the most common maternal substance found, while neonates most often tested positive for methadone. Nearly 90% of the mothers smoked. Thirty-four of the mothers were found to continue illicit drug abuse while pregnant, while another eight were seen in a methadone clinic for a history of abuse. Most of the neonates required weaning with methadone. The majority of our study cases were funded by Medicaid, mostly by West Virginia with total hospital costs exceeding 1.7 million dollars. Direct cost attributed to detoxification was in excess of $180,000. The number of neonates diagnosed with Neonatal Abstinence Syndrome has nearly tripled from 2003 to 2007. The problem of maternal drug abuse and addiction during pregnancy has dramatic effects on both their unborn children and our local healthcare system. Increased awareness of this growing problem is needed so that earlier interventions can be implemented. It is our opinion that all obstetrical patients at risk should be screened early and often so that those affected individuals can be managed more aggressively to improve neonatal outcomes

Common Ethical Challenges in End of Life Care

Conflict is common in end-of-life situations. This session will be an interactive session in which we explore common conflicts that emerge between caregivers, patients, and care providers, and apply ethical principles to trying to approach these conflicts. At the end of the session, participants will be able to: Discuss an ethical framework for approaching conflict in health care Discuss the ethical challenges in balancing a patient or family’s hope for a miracle with health care providers’ concerns about providing care that is likely to be non-beneficial Discuss an approach to addressing families’ request not to provide pain medication to a person who appears to be sufferin