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Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs
Veeral N Tolia1, Stephen W Patrick, Monica M Bennett
1From the Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Pediatrix Medical Group (V.N.T.), and the Office of the Chief Quality Officer, Baylor Scott and White Health (M.M.B.) - all in Dallas; the Mildred Stahlman Division of Neonatology, Department of Pediatrics, and the Vanderbilt Center for Health Services Research and Department of Health Policy, Vanderbilt University School of Medicine, Nashville (S.W.P.); the Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann and Robert H. Lurie Children's Hospital of Chicago - both in Chicago (K.M.); the Department of Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton (J.S.), and the Center for Research, Education, and Quality, Mednax, Sunrise (R.H.C., A.R.S.) - both in Florida; the Department of Pediatrics, Duke University School of Medicine, Durham, NC (P.B.S.); and Pediatrix Medical Group, Greenville Memorial Hospital, Greenville, SC (R.H.C.).
Insights
The incidence of neonatal abstinence syndrome (NAS) increased significantly in US NICUs from 2004-2013. This rise led to longer hospital stays and greater resource utilization for affected infants.
Area of Science:
- Neonatalogy
- Public Health
- Pharmacology
Background:
- Neonatal Abstinence Syndrome (NAS) incidence has risen due to increased in utero opioid exposure.
- Recent trends in NAS incidence and treatment remain poorly characterized.
Purpose of the Study:
- To analyze trends in NAS incidence, healthcare utilization, and clinical characteristics.
- To assess changes in NAS treatment and resource allocation in Neonatal Intensive Care Units (NICUs).
Main Methods:
- Utilized cross-sectional analyses of deidentified data from 299 US NICUs (2004-2013).
- Evaluated trends in NICU admissions, length of stay, and pharmacotherapy use for infants with NAS.
Main Results:
- NAS admissions per 1000 NICU admissions increased from 7 to 27.
- Median length of stay rose from 13 to 19 days; NICU days for NAS grew from 0.6% to 4.0% nationally.
- Pharmacotherapy use increased, with morphine being the most common drug.
Conclusions:
- NAS represented a substantial and increasing burden on NICU resources nationwide.
- The study highlights the growing impact of NAS on critical care neonatology.
Background:
The incidence of the neonatal abstinence syndrome, a drug-withdrawal syndrome that most commonly occurs after in utero exposure to opioids, is known to have increased during the past decade. However, recent trends in the incidence of the syndrome and changes in demographic characteristics and hospital treatment of these infants have not been well characterized.
Methods:
Using multiple cross-sectional analyses and a deidentified data set, we analyzed data from infants with the neonatal abstinence syndrome from 2004 through 2013 in 299 neonatal intensive care units (NICUs) across the United States. We evaluated trends in incidence and health care utilization and changes in infant and maternal clinical characteristics.
Results:
Among 674,845 infants admitted to NICUs, we identified 10,327 with the neonatal abstinence syndrome. From 2004 through 2013, the rate of NICU admissions for the neonatal abstinence syndrome increased from 7 cases per 1000 admissions to 27 cases per 1000 admissions; the median length of stay increased from 13 days to 19 days (P<0.001 for both trends). The total percentage of NICU days nationwide that were attributed to the neonatal abstinence syndrome increased from 0.6% to 4.0% (P<0.001 for trend), with eight centers reporting that more than 20% of all NICU days were attributed to the care of these infants in 2013. Infants increasingly received pharmacotherapy (74% in 2004-2005 vs. 87% in 2012-2013, P<0.001 for trend), with morphine the most commonly used drug (49% in 2004 vs. 72% in 2013, P<0.001 for trend).
Conclusions:
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.
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