From 2004 through 2013, the neonatal abstinence syndrome was responsible for a substantial and growing portion of resources dedicated to critically ill neonates in NICUs nationwide.

In recent years, neonatal abstinence syndrome (NAS), which commonly occurs after opioid use in pregnant women, has increased, nearly tripling in the United States between 2000 and 2009. There are limited data on the treatment of infants with NAS or changes in neonatal intensive care units. Previous studies have focused on specific geographic areas or used hospital billing records, not infant-specific clinical information, to identify cohorts. This study aims to analyze changes in incidence as well as treatment of infants with NAS in neonatal intensive care units (NICUs) across the United States from 2004 to 2013.Data were collected from Pediatrix Clinical Data Warehouse, which includes information from NICUs in 33 states and Puerto Rico. Infants were excluded if they had major congenital anomalies, if they were born before 34 weeks, if they were admitted only for suspected cases or to rule out NAS, or if they had exposure to narcotics but were not diagnosed with NAS. Infants were grouped by year of discharge in 1-year periods. Multiple cross-sectional analyses were performed using general linear regression.A total of 10,327 infants from 299 centers met diagnostic criteria for NAS. The frequency of infants with NAS admitted to NICUs increased from 7 cases per 1000 admissions to 27 cases per 1000 admissions between 2004 and 2013 and increased more rapidly between 2009 and 2013 than between 2004 and 2008. The length of hospital stay also increased from 13 to 19 days between 2004 and 2013, and the number of NICU hospital days attributed to NAS increased from 0.6% in 2004 to 4.0% in 2013 (P < 0.001 for trend). The proportion of infants treated for NAS with pharmacotherapy increased from 74% to 87% (P < 0.001 for trend), and the mean duration of therapy increased (P < 0.001 for trend). Whereas the ratio of days of therapy to NICU days increased (P = 0.004 for trend), the proportion of infants discharged while receiving medications decreased (4% in 2004-2005 vs 2% in 2012-2013, P < 0.001 for trend). The most commonly used medication was morphine, and the proportion of infants on morphine increased from 49% in 2004 to 72% in 2013 (P < 0.001 for trend). Between 2004Between and 2013Between , clonidine use increased, and between 2011Between and 2013 The study found that between 2012 and 2013, many mothers of affected infants used opioid pain relievers rather than illicit drugs, which is consistent with reports suggesting that increased opioid use in pregnant women is in part causing the increase in the incidence of NAS. The study also found increases in the utilization of resources for infants with NAS in NICUs between 2004 and 2013, and effective strategies for antenatal prevention and postnatal treatment of NAS are needed. These findings also support the need to address the current opioid use and abuse epidemic in the United States. 551Newborn Medicine

The prevalence of gastroschisis increased from 1997 to 2008, and then declined thereafter.

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