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Published on: August 25, 2014
Neonatal abstinence syndrome and infant mortality and morbidity: a population-based study
Sarka Lisonkova1,2, Qi Wen1, Lindsay L Richter1
1Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
Insights
Infants with neonatal abstinence syndrome (NAS) showed higher mortality and hospitalizations initially, but this risk decreased after accounting for maternal factors. Integrated care is crucial for supporting these infants and mothers.
Area of Science:
- Neonatal health
- Pediatric outcomes
- Public health
Background:
- Neonatal Abstinence Syndrome (NAS) impact on infant health remains understudied.
- Examined infant mortality and hospitalizations in newborns diagnosed with NAS.
- Focused on the first year of life for infants with NAS.
Purpose of the Study:
- To investigate infant mortality and hospitalization rates in infants diagnosed with Neonatal Abstinence Syndrome (NAS).
- To assess the association between NAS and adverse infant outcomes, considering maternal factors.
- To evaluate trends in foster care placement for infants with NAS.
Main Methods:
- Utilized linked administrative data from British Columbia, Canada (2004-2020) for over 696,900 live births.
- Identified NAS cases using ICD-10-CA codes.
- Employed generalized estimating equation models to adjust for maternal factors and analyze infant mortality and hospitalizations.
Main Results:
- Infants with NAS had a 2.5-fold higher unadjusted infant mortality rate, primarily post-discharge.
- Adjusted analysis showed diminished differences in infant death (AOR 0.85) but increased adjusted odds for post-discharge death (AOR 1.75).
- Hospitalization rates post-neonatal discharge were higher for infants with NAS (22.3% vs. 10.7%), and foster care placement declined significantly.
Conclusions:
- Unadjusted data indicated higher post-discharge mortality and hospitalizations for infants with NAS.
- After adjustment for maternal and socio-medical factors, the association with increased infant mortality diminished.
- Integrated care services are vital for supporting infants with NAS and their mothers, despite NAS not being an independent predictor of mortality.
Background:
Infant health among newborns with neonatal abstinence syndrome (NAS) has been understudied. We examined infant mortality and hospitalizations among infants diagnosed with NAS after birth.
Methods:
All live births in British Columbia (BC), Canada, for fiscal years from 2004-2005 to 2019-2020, were included (N = 696,900). NAS was identified based on International Classification of Diseases, version 10, Canadian modification (ICD-10-CA) codes; the outcomes included infant death and hospitalizations during the first year of life, ascertained from BC linked administrative data. Generalized estimating equation models were used to adjust for maternal factors.
Results:
There were 2,439 infants with NAS (3.50 per 1,000 live births). Unadjusted for other factors, infant mortality was 2.5-fold higher in infants with vs. without NAS (7.79 vs. 3.08 per 1,000 live births, respectively) due to increased post-discharge mortality NAS (5.76 vs. 1.34 per 1,000 surviving infants, respectively). These differences diminished after adjustment: adjusted odds ratio (AOR) for infant death was 0.85 [95% confidence interval (CI): 0.52-1.39]; AOR for post-discharge death was 1.75 (95% CI 1.00-3.06). Overall, 22.3% infants with NAS had at least one hospitalization after post-neonatal discharge, this proportion was 10.7% in those without NAS. During the study period, discharge to foster care declined from 49.5% to 20.3% in infants with NAS.
Conclusion:
Unadjusted for other factors, infants with NAS had increased post-discharge infant mortality and hospitalizations during the first year of life. This association diminished after adjustment for adverse maternal and socio-medical conditions. Infants with NAS had a disproportionately higher rate of placement in foster care after birth, although this proportion declined dramatically between 2004/2005 and 2019/2020. These results highlight the importance of implementing integrated care services to support infants born with NAS and their mothers during the first year of life and beyond, even though NAS itself is not independently associated with increased infant mortality.
