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