Long-term Healthcare Utilization by Medicaid Enrolled Children with Neonatal Abstinence Syndrome

Area of Science:

• Pediatrics
• Neonatal Health
• Healthcare Services Research

Background:

• Neonatal abstinence syndrome (NAS) is a growing concern, impacting healthcare resource allocation.
• Understanding long-term healthcare utilization for infants with NAS is crucial for effective resource planning and intervention strategies.

Purpose of the Study:

• To evaluate healthcare utilization in Medicaid-enrolled children diagnosed with neonatal abstinence syndrome (NAS) within the first two years of life.
• To determine if NAS is an independent predictor of increased healthcare utilization after controlling for confounding factors.

Main Methods:

• A retrospective, longitudinal cohort study design was employed, analyzing Medicaid data from New York and Texas.
• Tapered propensity score matching was used to compare children with NAS to similar children without NAS, controlling for demographics and clinical covariates.
• Poisson and negative binomial regression models calculated healthcare utilization ratios (HUR) for inpatient days, emergency department visits, and outpatient visits.

Main Results:

• Initially, children with NAS showed higher inpatient days and emergency department visits.
• After matching on clinical covariates and adjusting for multiple comparisons, these differences were no longer statistically significant for inpatient days and emergency visits.
• Children with NAS had significantly fewer outpatient office visits (HUR, 0.91; P < .0001).

Conclusions:

• Neonatal abstinence syndrome is not an independent predictor of increased healthcare utilization in the first two years of life.
• Observed healthcare utilization differences may be attributed to associated perinatal complications and congenital anomalies rather than NAS itself.
• Findings suggest a need to investigate underlying factors contributing to healthcare use in infants with prenatal drug exposure.