Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome

Abstract

Objective Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that may last for months. Our objective was to determine if infants with NAS are at increased risk for hospital readmission compared with uncomplicated term and late preterm newborns. Methods In this longitudinal retrospective cohort study, administrative data were used for all births from 2006 to 2009 in the New York State Inpatient Database. We identified infants with NAS, born late preterm or uncomplicated term, as independent groups using diagnostic codes and determined readmission rates. We fit a multivariable logistic regression model with 30-day readmission after discharge as the outcome and infant characteristics, clinical morbidities, insurance type, and length of birth hospitalization as predictors. Results From 2006 to 2009 in New York State, 700613 infants were classified as uncomplicated term, 51748 were born late preterm, and 1643 infants were diagnosed with NAS. After adjusting for confounders, infants with NAS (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.75–3.55) were more likely than uncomplicated term infants to be readmitted within 30 days of birth hospitalizations. The risk of readmission was similar to late preterm infants (OR 2.26, 95% CI 2.09–2.45). Length of birth hospitalization in days was inversely related to odds of being readmitted within 30 days of birth hospitalization (OR 0.94 95% CI 0.92–0.96). Conclusions When compared with uncomplicated term infants, infants diagnosed with NAS were more than twice as likely to be readmitted to the hospital. Future research and state-level policies should investigate means to mitigate risk of hospital readmission for infants with NAS.

Outpatient Healthcare Access and Utilization for Neonatal Abstinence Syndrome Children: A Systematic Review

“…Seven studies included in the final review examined healthcare utilization following the birth hospitalization. These studies are summarized in Table 2 [26]. This study also found that, compared to the other cohorts, NAS infants had higher hospital readmission rates.…”

“…The epidemiological expansion of NAS throughout resource-limited regions, such as rural areas, increases the complexity of providing comprehensive care for these children [7,12]. These factors can negatively affect NAS infants and utilization of healthcare [18,22,[34][35][36][37] Four of the utilization studies employed multivariate analysis to control for maternal and child factors that could influence result [25][26][27][28]. These studies have reported that NAS represents an independent overall health and/or healthcare utilization risk factor.…”

“…Readmission rates were higher in NAS patients in three of the included studies. Patrick et al noted increased odds of 30-day readmission following birth hospitalization among both NAS (OR = 2.49) and late preterm infants (OR = 2.26) compared to uncomplicated term infants after adjusting for sex, birth weight, comorbidities, and insurance type [26]. Similarly, Uebel et al demonstrated a higher likelihood of readmission among NAS children (OR = 1.63) along with a higher mortality (OR = 3.25) compared to non-NAS children.…”

Admissions and Emergency Visits by Late Preterm Singletons and Twins in the First 5 Years: A Population-Based Cohort Study

“…Late preterm infants born at 34 0/7 to 36 6/7 weeks' gestation were compared with term infants born at 37 0/7 to 41 6/7 weeks' gestation. Potential confounders included maternal characteristics (maternal age [ 18,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], !37 years of age], multigravida, preeclampsia or eclampsia, gestational diabetes, premature rupture of membranes, placental abruption, cesarean section, oxytocin use, neighborhood income) and infant characteristics (twin status, sex, small for gestational age [<10 percentile], neonatal care levels of birth hospitals, and infants' complications during birth hospitalizations including hypoglycemia, jaundice, feeding or gastrointestinal problems, cardiorespiratory problems, neurological problems or asphyxia, sepsis). The maternal neighborhood income was categorized into low (the lowest quintile), medium (the second to fourth quintiles), and high level (the highest quintile) based on maternal postal code using Statistics Canada census data.…”

The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care

“…Infants with NAS have an increased risk for adverse postdischarge outcomes, including hospital readmission, child abuse and neglect 76 77. The process for discharging an infant with NAS should begin before the infant is deemed suitable and involves interaction between parents, physicians, social workers and community services.…”