Neonatal Abstinence Syndrome up 300% in States With Data, CDC Reports

Beth Skwarecki

August 16, 2016

Incidence of neonatal abstinence syndrome (NAS) tripled between 1999 and 2013 in the 28 states in which data are available, according to the Centers for Disease Control and Prevention (CDC). Overall, the rate increased from 1.5 to 6.0 cases per 1000 live births. Three states were counting more than 30 cases per 1000 live births by the end of the study period: West Virginia, Vermont, and Maine.

"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," Jean Ko, PhD, from the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, and colleagues write in an article published in the August 12 issue of the Morbidity and Mortality Weekly Report. Opioid use is responsible for most cases of NAS, although this report did not distinguish between cases caused by opioids and other types of drug use.

Data for the study came from states' all-payer databases of hospital discharges. The investigators included all records that contained codes for a live birth and drug withdrawal in a newborn. They excluded cases in which a newborn was transferred from another hospital, to avoid possible duplication, and they also excluded cases in which drug exposure was likely to have occurred after birth in a neonatal intensive care unit. In total, the investigators considered 29,944,574 births, including 74,576 cases of NAS.

In 1999, rates of NAS varied from 0.3 per 1000 births in Iowa to 7.6 per 1000 births in Maryland. By 2013, the rates ranged from a low of 0.7 per 1000 in Hawaii to a high of 33.4 per 1000 in West Virginia. Among the 27 states with at least 3 years of data, the rate increased significantly (P < .05) in 25 of them. California and South Dakota were the states without detectable increases. The rate change was lowest in Hawaii (0.05 per 1000) and highest in Vermont (3.6 per 1000).

The authors caution that the results cannot be generalized to the United States as a whole, nor to the 1.5% of births that occur outside of hospitals. They also note that a change in the rate of incidence in a state may not mean a change in the total number of babies with NAS if the number of births decreased.

To reduce the opioid dependence that leads to NAS, the authors highlight the CDC's opioid prescribing guidelines, released earlier this year. Most states are also implementing prescription drug monitoring programs to reduce inappropriate prescribing. Four states (Florida, Georgia, Kentucky, and Tennessee) have also made NAS a reportable condition, which the authors say is important to make sure states have the resources to provide and target treatment to those who need it.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2016;65:799-802. Full text

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