Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012

Abstract

Objective Neonatal abstinence syndrome (NAS), a postnatal opioid withdrawal syndrome, increased 3-fold from 2000 to 2009. Since 2009, opioid pain reliever prescriptions and complications increased markedly throughout the US. Understanding recent changes in NAS and its geographic variability would inform state and local governments in targeting public health responses. Study Design We utilized diagnostic and demographic data for hospital discharges from 2009 to 2012 from the Kids’ Inpatient Database and the Nationwide Inpatient Sample. NAS-associated diagnoses were identified utilizing ICD-9-CM codes. All analyses were conducted with nationally weighted data. Expenditure data were adjusted to 2012 US dollars. Between-year differences were determined utilizing least squares regression. Results From 2009 to 2012, NAS incidence increased nationally from 3.4 (95%CI: 3.2-3.6) to 5.8 (95%CI 5.5-6.1) per 1,000 hospital births, reaching a total of 21,732 infants with the diagnosis. Aggregate hospital charges for NAS increased from $732M to $1.5B (p<0.001), with 81% attributed to state Medicaid programs in 2012. NAS incidence varied by geographic Census division, with the highest incidence rate (per 1000 hospital births) of 16.2 (95%CI 12.4-18.9) in the East South Central Division (KY, TN, MS, AL) and the lowest in West South Central Division 2.6 (95%CI 2.3-2.9; [OK, TX, AR, LA]). Conclusion NAS incidence and hospital charges grew substantially during our study period. This costly public health problem merits a public health approach to alleviate harm to women and children. States, particularly in areas of the country most affected by the syndrome, must continue to pursue primary prevention strategies to limit the effects of opioid pain reliever misuse.

Improving Care for Neonatal Abstinence Syndrome

“…12 Over the last decade, the rate of NAS has grown substantially across the United States; however, LOS has remained stagnant. 2,6 Data suggest that hospitals vary in identification 8 and management 7,8 of infants with NAS. There have been several innovations over the last decade in the management of opioid-dependent mothers 13 and infants with NAS, 14,15 but it is unclear how broadly these innovations have been adopted.…”

“…1 Over the last decade, the number of infants with NAS grew nearly 5-fold, in parallel with an increase in opioid use in pregnancy. [2][3][4][5][6] Although the number of infants with NAS grew, several studies reported variable approaches to diagnosis and treatment of the syndrome. 7,8 In response to the growth and variable treatment of these infants with NAS, the American Academy of Pediatrics (AAP) released a policy statement in 2012 calling for standardization of care delivered to infants with the syndrome.…”

The Impact of Neonatal Abstinence Syndrome: The View from a Rural Kentucky Hospital

“…Neurological, gastrointestinal, and respiratory systems are affected by neonatal abstinence syndrome and the severity of symptoms varies depending on dosage of the drug, genetic factors, adequacy of prenatal care, and gestational age of exposure. 1 Specific signs and symptoms include irritability, high pitched crying, tremors, frequent yawning, excessive crying, seizures, poor feeding, tachypnea, and loose stools. 1 In 2012, one infant born in the United States every twenty-five minutes was diagnosed with NAS.…”

“…1 Specific signs and symptoms include irritability, high pitched crying, tremors, frequent yawning, excessive crying, seizures, poor feeding, tachypnea, and loose stools. 1 In 2012, one infant born in the United States every twenty-five minutes was diagnosed with NAS. 1 In 2009 an estimated $720 million in hospital charges were attributed to NAS.…”

“…1 Infants exposed in utero to drugs such as opioids, cocaine or methamphetamine are expected to develop some degree of neonatal abstinence syndrome as they undergo withdrawal abruptly after birth. Neurological, gastrointestinal, and respiratory systems are affected by neonatal abstinence syndrome and the severity of symptoms varies depending on dosage of the drug, genetic factors, adequacy of prenatal care, and gestational age of exposure.…”