360 - Outcomes of drug exposed infants: An NCANDS data analysis

Publication Number: 360.5738

Rebecca Slutsky, New York University Grossman School of Medicine, New York, NY, United States; Sean M. Bailey, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Vincent J. Palusci, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States

Background: Prenatal substance exposure is a growing public health concern with significant maternal and child health implications. In response, public policy has evolved, with many states now implementing Plans of Safe Care (PoSC) and Comprehensive Addiction and Recovery Act (CARA) referrals. The National Child Abuse and Neglect Data System (NCANDS) provides unique outcome data for infants with prenatal substance exposure (IPSE).

Objective: Using NCANDS, we (1) described a cohort of infants reported to Child Protective Services for prenatal substance exposure from 2018-22; (2) identified health and developmental outcomes of maltreatment victims over a 5yr period; and (3) described outcomes associated with PoSC and CARA referrals.

Design/Methods: NCANDS datasets for FY2018-2022 were linked so that individual children could be identified from birth through 3-5 years. Comparisons were made between the IPSE infants and a neglect control group for child, family and service factors. Outcomes were compared for the groups in the last confirmed reports.

Results: There were 25,931 IPSE and 49,362 controls with confirmed neglect in FY2018. A significantly higher proportion of IPSEs were Black compared to controls (32.9% v 26.0%, p< 0.001), while the percentage of Hispanic infants was significantly lower in IPSEs (12% v 25%, p< 0.001). Most (40.1%) IPSE families had single parents present with identified alcohol (12.9%) and drug (61.3%) problems. Most (58.6%) had one or more service referrals, including PoSC (75.4%) or specific CARA services (49.4%). Among children with last confirmed reports after age 2y, 35.1% had PoSC and 27.6% had CARA services. Significantly more PoSC and CARA services were made for Black children, while fewer PoSC were offered for White and Hispanic children. Both IPSE with PoSC and IPSE with CARA services were significantly less likely to have medical problems noted on their last confirmed report (OR=0.34, 95% CI=0.18, 0.63; OR=0.36, 95% CI=0.18, 0.72, respectively) along with reduced additional drug or alcohol exposure, housing/financial issues, and family violence. However, both groups were more likely to receive public assistance (OR=3.82, 95% CI=2.82, 5.19; OR=3.33, 95% CI=2.42, 4.59, respectively).

Conclusion(s): Infants with prenatal substance exposure had higher rates of later drug and alcohol exposure, medical issues, family alcohol, drug and emotional problems. Those with PoSC and CARA services had better outcomes, which underscores the need for targeted interventions and further evaluation of current systems to address the unique challenges of IPSE as policy continues to evolve.