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Study: Neonatal abstinence syndrome increasing

Tuesday May 1, 2012
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Between 2000 and 2009 in the United States, the annual rate of maternal opiate use increased nearly fivefold, while diagnosis of neonatal abstinence syndrome among newborns increased almost threefold and was accompanied by a substantial increase in related hospital charges, according to a study.

A recent national study indicated that 16.2% of pregnant teens and 7.4% of pregnant women ages 18 to 25 use illicit drugs. Neonatal abstinence syndrome "most commonly occurs in the context of antepartum opiate use, although other drugs have also been implicated," the authors wrote in background information for the study, which appeared April 30 on the website of JAMA and was scheduled for presentation in Boston at the annual meeting of the Pediatric Academic Societies.

"In addition to NAS, illicit drug use (specifically opioid dependence) during pregnancy is associated with a significantly increased risk of adverse neonatal outcomes such as low birthweight (less than 2,500 grams [5.5 pounds]) and mortality," the authors wrote. Neonatal abstinence syndrome is characterized by a wide array of signs and symptoms including increased irritability, hypertonia, tremors, feeding intolerance, seizures and respiratory distress.

Symptoms of withdrawal associated with NAS have been described in 60% to 80% of newborns exposed to heroin or methadone in utero. Before this study, the researchers said, there were no estimates of the national incidence of NAS across the United States in the context of opiate use during pregnancy.

Stephen W. Patrick, MD, MPH, MS, of the University of Michigan Health System in Ann Arbor, and colleagues conducted a study to examine patterns in the national incidence of NAS and maternal opiate use at the time of delivery and to characterize trends in national healthcare expenditures associated with NAS between 2000 and 2009.

They found the rate of newborns diagnosed with NAS increased from 1.2 to 3.39 per 1,000 hospital births per year during that span. The number of mothers using or dependent on opiates increased from 1.19 to 5.63 per 1,000 hospital births per year.

The authors wrote that compared with all other hospital births, newborns with NAS were significantly more likely to have respiratory diagnoses (30.9% more likely), low birthweight (19.1%), feeding difficulties (18.1%) and seizures (2.3%). Newborns with NAS also were more likely to be covered by Medicaid (78.1% more likely) and reside in zip codes with the lowest income quartile (36.3%).

Average hospital charges for newborns diagnosed with NAS increased by 35% between 2000 and 2009, from $39,400 to $53,400. The hospital length-of-stay for newborns diagnosed with NAS averaged 16 days, and remained relatively unchanged during the study period. Between 2000 and 2009, total hospital charges for NAS are estimated to have increased from $190 million to $720 million, adjusted for inflation. In 2009, the researchers wrote, the estimated number of newborns with NAS was 13,539 — approximately one infant born per hour in the United States with signs of drug withdrawal.

"In conclusion, newborns with NAS experience longer, often medically complex and costly initial hospitalizations," the authors wrote. "The increasing incidence of NAS and its related healthcare expenditures call for increased public health measures to reduce antenatal exposure to opiates across the United States.

"In addition, further innovation and standardization of treatment of NAS may mitigate NAS symptoms and reduce hospital [length-of-stay]. States are poised to seek innovative solutions to decreasing the burden of NAS, because the majority of hospital expenditures for this condition are shouldered by state Medicaid programs."

To read the study, visit http://bit.ly/IL0TS7.

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