Birth hospitals' role in access to early intervention services among drug-exposed infants

BACKGROUND: Birth hospitals could support secondary prevention efforts for drug-exposed infants (DEI) through referral to Part C Early Intervention (EI), but data on hospital referrals and EI service access predictors are lacking. METHODS: A population-based analysis of 1998-2005 Massachusetts maternity hospital births identified 6,302 DEI who survived the neonatal period. Linkages to EI program data measured access from 1998-2008. Generalized estimating equations measured associations between EI access and neonatal abstinence syndrome (NAS) diagnosis, toxicology screen results, maternal race/ethnicity, insurance, and hospital maternity level of care. Interactions between NAS diagnosis/toxicology results and race/ethnicity, insurance and hospital maternity level were examined. RESULTS: While 59% of DEI were referred overall, hospitals referred only 12.8%. Referral probabilities were higher for NAS vs. no NAS (adjusted odds ratio [aOR] 2.5, 95% confidence interval 2.1-3.0), positive vs. negative toxicology screens (aOR 1.5, 1.2-1.9); and no or public vs. private insurance (aOR 1.9, 1.1-3.4 and 2.3, 1.9-2.9, respectively). Referral probabilities were lower for well-baby vs. neonatal intensive care nursery births (aOR 0.7, 0.6-1.0) and Asian/Pacific Islanders vs. Non-Hispanic Whites (aOR 0.5, 0.3-0.8). Interactions revealed lower referral rates associated with NAS diagnosis and positive toxicology results for privately insured infants. Similarly, interactions revealed lower referral rates associated with NAS diagnosis and positive toxicology screens for children born in well-baby nurseries. CONCLUSIONS: Hospital referral rates were low and referral response to NAS diagnosis and positive toxicology screens was inconsistent. Policies promoting hospital referral could improve DEI access to EI, and differential referral for privately insured infants warrants further investigation.