Todd Davies | Marshall University (original) (raw)

Papers by Todd Davies

Marshall journal of medicine, Apr 1, 2016

Journal of neonatal-perinatal medicine, Apr 10, 2020

The purpose of this study was to describe an identified association between necrotizing enterocol... more The purpose of this study was to describe an identified association between necrotizing enterocolitis (NEC) and prenatal opioid exposure with neonatal abstinence syndrome (NAS) in late preterm and full-term neonates. STUDY DESIGN: In this single-center retrospective cohort study, we analyzed inborn neonates with the diagnosis of NEC discharged from 2012 through 2017. We compared infants with NEC > 35 weeks' gestation to those with NEC<35 weeks' gestation. We compared gestational age, birth weight, age of onset of symptoms, and incidence of prenatal drug exposure between groups. Significance was determined using Mann-Whitney and Fisher's exact tests. RESULTS: Over the study period, 23 infants were identified with NEC, 9 (39%) were babies > 35 weeks at birth and 14 (61%) < 35 weeks. Those > 35 weeks had a higher birth weight, earlier onset of symptoms, and a higher percentage of prenatal exposure to opioids compared to those < 35 weeks' gestation. We further described seven infants with late gestational age onset NEC associated with prenatal opioid exposure. CONCLUSIONS: In this cohort of infants with NEC discharged over a 6 year period we found a higher than expected percentage of infants born at a later gestational age. We speculate that prenatal opioid exposure might be a risk factor for NEC in neonates born at > 35 weeks.

The Journal of Pediatrics, Feb 1, 2017

We report a retrospective case series of 19 infants exposed to both opioids and gabapentin prenat... more We report a retrospective case series of 19 infants exposed to both opioids and gabapentin prenatally. We describe a unique behavioral phenotype in 15 of these infants and report a treatment strategy.

New England Journal of Medicine, 2019

n the United States, deaths due to suicide and unintentional overdose pose a major, and growing, ... more n the United States, deaths due to suicide and unintentional overdose pose a major, and growing, public health concern. The combined number of deaths among Americans from suicide and unintentional overdose increased from 41,364 in 2000 to 110,749 in 2017 and has exceeded the number of deaths from diabetes since 2010. 1 The increase represents more than a doubling in the age-adjusted rate of deaths from suicide and unintentional overdose (Table 1), according to data from national surveillance systems. 2 Accordingly, both suicide and unintentional overdose have been the focus of large-scale prevention efforts, such as the National Strategy for Suicide Prevention 3 and the State Targeted Response to the Opioid Crisis grant program of the Substance Abuse and Mental Health Services Administration. Both problems have connections with pain and opioid use. 4-8 The use of potentially lethal drugs such as opioids has a clear, direct relationship to the risk of unintentional overdose. Perhaps less well known, opioids also are linked to suicide risk. 9 Furthermore, opioid use disorders have a distinctly strong relationship with suicide as compared with other substance use disorders. 10 In all, more than 40% of suicide and overdose deaths in 2017 were known to involve opioids (Table 1), with many more likely to have had unrecorded opioid involvement. The common theme of opioid use underlying suicide and overdose poses questions of how these problems may be related to one another. 6 This review describes what is known about the links between suicide and overdoses, with a focus on pathways through opioid use, issues of intent, risk factors, prevention strategies, and unresolved issues. Biol ogic, Medic a l , a nd Soci a l Fac t or s a s Link s Many factors promote the initiation and persistence of opioid use, but several specific pathways toward vulnerability to overdose and suicide are worth highlighting. Pain and Risk of Suicide and Overdose Pain causes alterations in the neurocircuitry related to reward, which result in vulnerability to suicide 11 and potentially to riskier use of opioids. This biologic mechanism is supported by epidemiologic data that have shown that chronic-pain diagnoses are linked to suicide, 12 and these associations are only partially explained by co-occurring mental health conditions. 5 Pain is also associated with opioid overdose, but in contrast to suicide, the limited analyses available suggest that this association is mediated by the quantity of opioids prescribed. 7 Medical-System Drivers of Opioid Prescribing Beginning in the early 2000s, opioids were increasingly used to treat chronic pain in the United States. This change came in response to concerns about the under

Journal of Perinatology, Jul 6, 2017

The purpose of this study was to test a specialized needs-based management model for a high volum... more The purpose of this study was to test a specialized needs-based management model for a high volume of babies born with neonatal abstinence syndrome (NAS) while controlling costs and reducing neonatal intensive care unit (NICU) bed usage. STUDY DESIGN: Data were analyzed from inborn neonates 435 weeks' gestational age with the diagnosis of NAS (ICD9-CM 779.5), requiring pharmacologic treatment and discharged from 2010 through 2015. Significance was determined using Kruskal-Wallis and Mann-Whitney as well as χ 2 for trend. RESULTS: NAS requiring medication treatment increased from 34.1 per 1000 live births in 2010 to 94.3 per 1000 live births in 2015 (P o0.0001 for trend). Hospital charges were significantly different in the three described locations (P o 0.

Annals of Internal Medicine, 2018

Duru and colleagues (1) highlight a potential confounder when evaluating patients for newonset am... more Duru and colleagues (1) highlight a potential confounder when evaluating patients for newonset amnesia. Because of the pervasive expansion of opioid use disorder in our society, this condition must now be considered in every avenue of medicine. However, nonmedical use of opioids-and even the basic pharmacology of these agents-is a complex issue. Many if not most persons who abuse opioids simultaneously abuse other substances. The authors thoroughly addressed concomitant use of various opioid derivatives, cocaine, and even synthetic opioids; however, they did not discuss gabapentin, which is frequently concomitantly abused with opioids (2) to potentiate the opioid effect (3). Patients receiving combination therapy with gabapentin and opioids often have more adverse events, including cognitive dysfunction (4). As a drug commonly abused with opioids for which memory loss is a known adverse effect (5), gabapentin should be considered when evaluating the amnestic syndrome reported by Duru and colleagues.

American Journal of Health Research

Background: Community isolation, poor economic conditions, intimate group structures and the natu... more Background: Community isolation, poor economic conditions, intimate group structures and the natural terrain creates unique challenges in both the treatment and study of opioid use disorder (OUD). The maternal and neonatal consequences for OUD can be profoundly altered by co-occurring psychiatric conditions in the mother, a phenomenon that may be more profound in rural communities. Because of these unique issues, the level of direct interaction in a patient-centric rural research design is critical to the effectiveness of the study. Objective: We set out to test the hypothesis that maternal stress and psychological state has a prolonged developmental impact on prenatally exposed children in rural areas by reducing needed stimulation in the caretaking environment. The study quickly changed as we discovered the geographic isolation and health disparate nature of the community had an important implication for research design and data collection. Methods: We used a typical patient-centered study design method for an observational study in rural West Virginia. Results: Original concise designs created complications for participants leading to recruitment difficulties and poor retention. Patients were resistant to study participation related to culture and severe community health disparities that were not identified until the patient population became comfortable with the research team. Conclusion: Despite the cultural and genetic background similarities between patients in less isolated areas and the test site, the geographic isolation and health disparate nature of the community had a profound effect on the research design. The findings in this study suggest a reevaluation of approaches to conducting research in rural isolated areas.

Neonatal Network, 2019

Tens of thousands of infants are impacted yearly by prenatal opioid exposure. The term neonatal o... more Tens of thousands of infants are impacted yearly by prenatal opioid exposure. The term neonatal opioid withdrawal syndrome (NOWS) is now replacing the more familiar term neonatal abstinence syndrome (NAS). Ongoing debate continues related to standard regimens for treatment of this oftentimes perplexing condition. Historically, treatment has focused on pharmacologic interventions. However, there is limited research that points to nonpharmacologic methods of treatment as viable options, whether alone or in addition to pharmacologic interventions. This article, utilizing a review of pertinent literature, outlines the physical aspects of NOWS, including its pathophysiology and the resulting physical clinical signs. In addition, we present an overview of how age-appropriate, nonpharmacologic interventions, centered on developmental care, may be a valuable approach to organize and prioritize routine care for these infants, their families, and the health care team facing the challenges of ...

Marshall Journal of Medicine, 2020

The incidence rate of schizencephaly is 1.5 in 100,000 live births and the rate of holoprosenceph... more The incidence rate of schizencephaly is 1.5 in 100,000 live births and the rate of holoprosencephaly is 1 in 16,000 live births. Both malformations are rare, but our institution has seen a dramatic increase in both malformations in recent years with no known cause. Schizencephaly is the most severe cortical malformation and holoprosencephaly is the most common defect in the prosencephalon during development. However, it is still not very common to see a fetus with this defect live to delivery. Our institution, a regional hospital in central Appalachia, has seen four cases of schizencephaly and three cases of holoprosencephaly within two years. No two neonates seem to share a common factor. All had different co-morbidities and presentations, all mothers were of different ages and showed few risk factors if any for these deformities. This paper is a report of the cases found of these rare birth defects seen at our institution in recent years.

American Journal of Case Reports, 2019

Congenital defects/diseases Background: With the increasing prevalence of substance use in pregna... more Congenital defects/diseases Background: With the increasing prevalence of substance use in pregnancy, the rates of neonatal abstinence syndrome (NAS) are dramatically increasing. There is little information on the use of multiple substances in adults, even less so of polysubstance abuse during pregnancy and the consequences for the fetus as well as the mother. Case Report: A newborn male born at 35 weeks presented post-delivery with hips bilaterally dislocated and hyperflexed. The patient's legs fully extended and their shoulders were bilaterally mid-flexed with arms fully extended. This neonate was also reported to have bilateral hearing and vision loss as well as NAS symptoms of high-pitched crying and respiratory distress. During pregnancy the mother in this case study admitted to using buprenorphine, benzodiazepines, gabapentin, and heroin. The consequences of using this combination has not been well studied in pregnancy. Conclusions: The presented case had severe complications, likely due to maternal polysubstance use and poor prenatal care in pregnancy. Clonidine was used to control the NAS symptoms, ranitidine was used to treat the gastroesophageal reflux, and glycopyrronium bromide was used for the neonate's excessive secretions. After delivery, the patient was placed on a nasal noninvasive cannula for respiratory distress and was transferred to a different hospital for treatment of the more serious comorbid conditions.

Marshall Journal of Medicine, 2019

Neonatal abstinence syndrome (NAS) is seen at a very high rate at our institution in Huntington, ... more Neonatal abstinence syndrome (NAS) is seen at a very high rate at our institution in Huntington, West Virginia, and the majority of exposures are polysubstance in nature. Polysubstance can have different meanings for different regions. At our institution, polysubstance is any combination of opioids, gabapentin, methamphetamine, cocaine, marijuana, benzodiazepines, nicotine or other neuroactive substances with three to four substances being the norm. Rapidly changing combinations of drug use and the lack of literature creates a difficult situation for clinicians who are often reliant on treatment recommendations that lack references or conclusive data supporting the clinical approaches. Elucidating withdrawal symptoms consistent with in utero exposures to particular drug combinations is difficult. Many substances induce similar withdrawal symptoms in neonates and the vast majority of cases present as polysubstance exposure. Standard methodology often leads to a research approach which isolates populations and substance of exposure to determine the individual effects on the neonate. In some drug combinations, like opioid and gabapentin exposure, the substances in concert create symptoms and complications that are not observed with either drug alone. The history of responses to substance use epidemics has been to handle each drug as a separate disease process; this is no longer a viable option. The following is a review of the literature available discussing individual substance withdrawal characteristics in neonates combined with the clinical insight gained at our hospital from treating such high rates of complex polysubstance exposure.

Marshall Journal of Medicine, 2017

The authors have no financial disclosures to declare and no conflicts of interest to report.

The Journal of Pediatrics, 2017

Marshall Journal of Medicine, 2016

International Journal of Clinical Pediatrics, 2018

In recent years, the clinical definition of neonatal abstinence syndrome (NAS) has been expanded ... more In recent years, the clinical definition of neonatal abstinence syndrome (NAS) has been expanded to describe neonates experiencing withdrawal due to in utero exposure to numerous neuroactive substances, not exclusively opioids. Complex NAS cases involving exposure to multiple and unusual narcotics have become widespread. Kratom is one such substance. It is extracted from tropical tree leaves, and can be used both as a recreational drug and to mitigate opioid withdrawal. Although kratom may potentially serve as a viable opioid alternative, its activity and the consequences of controlled use are largely unstudied, particularly in the pregnant population. A newborn male infant was not initially identified as being at risk for withdrawal due to no maternal admission of substance use and maternal urine drug screen was negative. On the first day of life (DOL), the neonate was observed to exhibit significant signs of withdrawal including high-pitched crying, facial grimacing, irregular respiratory pattern, mottling, and mild undisturbed tremors. Upon interview with the mother it was noted that there was heavy caffeine use, daily cigarette smoking, daily use of the "herbal alternative" (kratom) throughout the pregnancy. In this report, we present a case of NAS precipitated by in utero exposure to kratom, discuss the present body of research regarding kratom and consider potential implications of escalating kratom use on the incidence and severity of NAS. For this prenatally exposed neonate, clonidine was successfully used to control withdrawal symptoms.

Journal of Perinatology, 2017

D57. SEPSIS: OF MICE, METABOLOMICS, AND MAN, 2012