Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013

Abstract

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction (1). During 2000-2012, the incidence of NAS in the United States significantly increased (2,3). Several recent publications have provided national estimates of NAS (2,3); however, data describing incidence at the state level are limited. CDC examined state trends in NAS incidence using all-payer, hospital inpatient delivery discharges compiled in the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) during 1999-2013. Among 28 states with publicly available data in HCUP during 1999-2013, the overall NAS incidence increased 300%, from 1.5 per 1,000 hospital births in 1999, to 6.0 per 1,000 hospital births in 2013. During the study period, significant increases in NAS incidence occurred in 25 of 27 states with at least 3 years of data, with annual incidence rate changes ranging from 0.05 (Hawaii) to 3.6 (Vermont) per 1,000 births. In 2013, NAS incidence ranged from 0.7 cases per 1,000 hospital births (Hawaii) to 33.4 cases per 1,000 hospital births (West Virginia). The findings underscore the importance of state-based public health programs to prevent unnecessary opioid use and to treat substance use disorders during pregnancy, as well as decrease the incidence of NAS.

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

“…Additionally, exposure may cause neonatal abstinence syndrome (NAS), in which the fetus develops symptoms of withdrawal following delivery (Kocherlakota, 2014; Stover and Davis, 2015). Since 1999, the incidence of NAS is estimated to have increased by over 300%, coinciding with the onset of today’s opioid epidemic (Ko et al, 2016). …”

An Outpatient Methadone Weaning Program by a Neonatal Intensive Care Unit for Neonatal Abstinence Syndrome

“…In 2012 alone the syndrome was diagnosed in 21,732 infants in the United States. [1][2][3] From 2000 to 2012, the rate of NAS in the United States has increased by nearly 5-fold. 1,2 In a study examining 299 neonatal intensive care units (NICUs) in the United States from 2004 through 2013, the rate of NICU admissions for NAS increased from 0.7% to 2.7% of all admissions and made up 4% of all NICU days.…”

“…4 Previous research has shown that inpatient management using traditional strategies of care for infants with NAS led to a length of stay ranging from 8-105 days with a median of 25-34 days. [3][4][5] Oei et al 6 found that inpatient length of stay was decreased with the establishment of an outpatient clinic designed specifically for managing NAS patients.…”

Neonatal abstinence syndrome: an update

“…The recent rise of opioid use in pregnancy and NAS has disproportionately occurred in rural areas (9, 10)** Using administrative data from 2004 to 2013, Villapiano et al(11)* found the incidence of NAS per 1000 hospital births increased from 1.2 to 7.5 among rural infants and from 1.4 to 4.8 among urban infants. The demographic differences between rural and urban areas is also apparent in state surveillance data.…”

“…Ko et al (10)** detailed state-specific NAS incidence rates per 1,000 hospital births in 2013. They found NAS incidence of 0.7 in Hawaii contrasted by 33.4 in West Virginia.…”