Trends in Neonatal Abstinence Syndrome

The numbers are hard to ignore. The incidence of Neonatal Abstinence Syndrome (NAS) has persistently risen over the past decade and seems to be projected to continue to increase.

Figure 1. NICU admissions for Neonatal Abstinence Syndrome from 2004-2013

The biggest indicator of this trend is that Neonatal Intensive Care Unit (NICU) admissions attributed to NAS have increased from 7/1000 to 27/1000 NICU cases over 2009-2014 (Figure 1). Admission to the NICU indicates that the newborn is in need of advanced medical attention, close monitoring, or specialized nursing care (Stanford Children's Hospital). Unfortunately, this rate of increase is significantly steeper than the rate of increase from 2004-2008 (Figure 1). Additionally, from 2009 to 2014, the length of stay in a NICU facility because of NAS diagnosis increased from an average of 13 days to an average of 19 (Tolia, Patrick, Bennett, Murthy, Sousa, Smith, Clark, & Spitzer, 2015). On average, newborns who are born addicted are more likely to be admitted to the NICU than those who are not, and will spend significantly more time in the NICU than newborns who need intensive care for other conditions. This also has implications on the cost of the hospital stay which was an average of 19 times more expensive for newborns with NAS than those without in a 2012 study (Figure 2).

Figure 2. Infographic from the National Institutes of Health.

Studies have also shown that a shift has occurred in the distribution of NAS among various ethnic groups. Compared to a measurement in 2004-2005 when 64% of mothers were of white race, there has been a significant increase to 76% of mothers being of white race in a 2012-2014 sample. At the same time, proportions of mothers from black races and Hispanic ethnic groups have correspondingly decreased (Tolia, et al, 2015). 

Geographically, the highest incidence rates of NAS at 16.2 cases per 1000 hospital births occur in the East South Central Division including the states of Kentucky, Tennessee, Mississippi and Alabama. New England holds the second highest incidence rate in the US at 13.7 cases for every 1000 hospital births (Patrick, Davis, Lehmann, & Cooper, 2015). 

Together, these statistics show an alarming increase in the incidence of NAS and the need for more intensive treatments in newborns affected by NAS. Dramatic efforts must be made to decrease the incidence of this risky condition. 

References

National Institutes of Health. (2015). Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome. Retrieved from www.drugabuse.gov.

Patrick, S., Davis, M., Lehmann, C., & Cooper, W. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology, 35(8), 650-655. doi:10.1038/jp.2015.36.

Stanford Children's Hospital. (2016). The Neonatal Intensive Care Unit (NICU). Retrieved from www.stanfordchildrens.org.

Tolia, V., Patrick, S., Bennett, M., Murthy, K., Sousa, J., Smith, B., Clark, R., & Spitzer, A. (2015). Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. The New England Journal of Medicine, 372(22), 2118-2126.

Search terms: epidemiology, neonatal abstinence syndrome, neonate, withdrawal, opioid, incidence, geographic, NICU

Prenatal Drug Exposure and Neonatal Abstinence Syndrome

Although every newborn faces incredible changes at the moment of birth, those that experience Neonatal Abstinence Syndrome (NAS) are faced with an extra challenge. NAS is defined as “a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb” (MedlinePlus, 2014). Prenatal exposure to opiates, narcotics, and other drugs can create unwitting newborn addicts whose bodies have become physiologically dependent on their mother’s drug(s) of choice. For these newborns at the moment of birth, even as their heart takes sole responsibility for circulating blood, and their lungs learn to suck in air instead of amniotic fluid, their entire body is wracked by dangerous withdrawals.

Image retrieved from www.medscape.com/viewarticle/840696

Unfortunately the sad reality is that these newborns are facing the harsh consequences of actions well beyond their control. While information about the risks of drug use during pregnancy is easily accessible and commonly shared by healthcare providers, many mothers still use or abuse dangerous drugs during pregnancy (Bersani, Corsello, Mastandrea, Patacchiola, Voligno, Garofalo, & Dotta). Besides the physiological implications of NAS, there are also social and legal implications of drug use during pregnancy. Any physician who identifies NAS or other symptoms of drug exposure in a newborn is required by the 2003 Keeping Children and Families Safe Act to report the findings to their state Child Protective Services. Procedures and guidelines for responding to these reports vary from state to state. But as of 2006, 13 states and the District of Columbia identify prenatal drug exposure as a form of child abuse or neglect which can have implications on the mother's ability to keep her baby after birth (U.S. Department of Health and Human Services, 2009).

The impact of prenatal drug exposure ranges from physiological, to social, and beyond. Healthcare providers must understand the challenges faced by both the mother and the baby when NAS or other symptoms of drug exposure occur in a newborn. Physicians, nurses, midwives, and others involved in the birthing process must know how to intervene effectively and respond compassionately when babies are born addicted.

References

Bersani, I., Corsello, M., Mastandrea, M., Patacchiola, V., Foligno, S., Garofalo, V., & Dotta, A. (2013). Neonatal abstinence syndrome. Early Human Development 89(4) S85-S87.

MedlinePlus. U.S. National Library of Medicine. (2014). Neonatal abstinence syndrome. Retrieved from www.nlm.nih.gov/medlineplus/ency/article/007313.htm

U.S. Department of Health and Human Services. (2009). Protecting children in families affected by substance use disorders. Child Abuse and Neglect User Manuel Series. Retrieved from www.childwelfare.gov/pubPDFs/substanceuse.pdf#page=51&view=CHAPTER 6 The Role of Child Protective Services When Substance Use Disorders AreIdentified