Kathleen Louden

May 06, 2013

CHICAGO — A single hospital's costs to treat neonatal abstinence syndrome in infants born to opioid-dependent mothers who received opioid replacement therapy during pregnancy totalled more than $4 million during a 3-year period, a new study shows.

"That's a lot of money," said principal investigator Kay Roussos-Ross, MD, a psychiatrist and obstetrician specializing in addiction medicine at the University of Florida Shands Hospital, in Gainesville. "It would be better to spend the money on prevention early on."

"It's important to screen women of reproductive age for substance abuse and to offer referral for treatment when patients screen positive," Dr. Roussos-Ross told Medscape Medical News..

She presented the study here at the American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference.

In addition to the financial costs, neonatal abstinence syndrome resulting from in utero exposure to methadone or buprenorphine also has high emotional costs, Dr. Roussos-Ross said.

"These moms are devastated when they see their babies withdrawing," she told conference delegates.

Single-Center Study

The investigators conducted the study to determine the average length of stay for observation and treatment of neonatal abstinence syndrome as well as the hospital charges associated with care of these newborns.

The study took place at a single tertiary-care hospital with a large Medicaid population.

From a retrospective chart review from December 1, 2008, through November 30, 2011, they identified 327 newborns who had a diagnosis of neonatal abstinence syndrome.

They excluded infants who were born at fewer than 36 weeks' gestation, had coexisting medical conditions or sepsis, were transferred to an outside hospital for continued treatment, or whose diagnosis was incorrect.

In the 3-year period, 160 neonates were eligible for the study: 40 in the first year, 57 in year 2, and 63 in year 3. In nearly all cases, the mother had received methadone maintenance treatment; in the remainder of cases, the mother had received buprenorphine, Dr. Roussos-Ross said. Neonates with a modified Finnegan score of 8 or higher were transferred to the hospital's level III neonatal intensive care unit, she said.

Those with consistent scores of at least 8 or a single score of 13 or higher received pharmacologic treatment with morphine.

The average length of stay for infants in the study ranged from 15.1 days in year 2 to 16.2 days in year 3, Dr. Roussos-Ross reported. The average total charge per infant and per hospitalization ranged from $19,535 in year 2 to $28,592 in year 3. Hospital costs per year for treating these neonates were $1.1 million in the first year, nearly $1.5 million in the second, and $1.8 million in the third year, according to the data presented.

Neonates who needed pharmacologic treatment had a much longer length of stay and greater hospital charges than infants who did not receive morphine (Table).

Table. Costs of Treating Neonatal Abstinence Syndrome

Outcome (Mean) Newborns With Neonatal Abstinence Syndrome Healthy Newborns (Hospital Average)
Did Not Receive Morphine (n = 66) Received Morphine (n = 94)
Length of stay, days 5 23 1 - 2
Total hospital charge per infant $4215 $43,000 $873 - $1746


Prevention Needed

Dr. Roussos-Ross recommended ways that physicians can help decrease the incidence of neonatal abstinence syndrome, including the following:

  • Use nonopioid pharmacologic management of pain in pregnant women, such as physical therapy and massage therapy.

  • In pregnant women being treated for opioid dependence, use the lowest effective dose of methadone or buprenorphine to prevent cravings and withdrawal symptoms.

  • Encourage long-acting contraceptive management for women of reproductive age in opioid-dependence treatment.

  • After delivery, consider weaning women from opioid treatment in a physician-supervised setting to help protect against relapse.

During the question-and-answer session, an audience member said, "Half of babies born in the US are unplanned, so recommending contraceptives for these women is important."

Moderator Norman Wetterau, MD, who was not involved in the study, told Medscape Medical News, "In an ideal world, you wouldn't give opioids to [young] women unless they are on contraceptives, but many physicians don't want to take the time to ask about birth control."

Asked to comment on the study, Dr. Wetterau, a specialist in addiction medicine practicing in Danville, New York, said that buprenorphine, rather than methadone, is more available in New York for opioid-dependent patients. He cited research published in the New England Journal of Medicine (2010;363:2320-2331) that found a shorter length of hospitalization for infants with neonatal abstinence syndrome due to in utero exposure to buprenorphine than for those exposed to methadone.

Dr. Roussos-Ross and Dr. Wetterau disclosed no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference. Paper 3. Presented April 26, 2013.


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