Neonatal Abstinence Syndrome and Associated Health Care Expenditures: United States, 2000-2009 | Neonatology | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.175.212.130. Please contact the publisher to request reinstatement.
1.
Substance Abuse and Mental Health Administration.  Office of Applied Studies, Results From the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011
2.
Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants.  Arch Pediatr Adolesc Med. 2006;160(2):173-17616461873PubMedGoogle ScholarCrossref
3.
Pierog S, Chandavasu O, Wexler I. Withdrawal symptoms in infants with the fetal alcohol syndrome.  J Pediatr. 1977;90(4):630-633839382PubMedGoogle ScholarCrossref
4.
Bauer CR, Langer JC, Shankaran S,  et al.  Acute neonatal effects of cocaine exposure during pregnancy.  Arch Pediatr Adolesc Med. 2005;159(9):824-83416143741PubMedGoogle ScholarCrossref
5.
Rementería JL, Bhatt K. Withdrawal symptoms in neonates from intrauterine exposure to diazepam.  J Pediatr. 1977;90(1):123-126830876PubMedGoogle ScholarCrossref
6.
Hulse GK, Milne E, English DR, Holman CDJ. The relationship between maternal use of heroin and methadone and infant birth weight.  Addiction. 1997;92(11):1571-15799519499PubMedGoogle ScholarCrossref
7.
Madden JD, Chappel JN, Zuspan F, Gumpel J, Mejia A, Davis R. Observation and treatment of neonatal narcotic withdrawal.  Am J Obstet Gynecol. 1977;127(2):199-201831502PubMedGoogle Scholar
8.
Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources.  BJOG. 2009;116(5):665-67119220239PubMedGoogle ScholarCrossref
9.
Minozzi S, Amato L, Vecchi S, Davoli M. Maintenance agonist treatments for opiate dependent pregnant women.  Cochrane Database Syst Rev. 2008;(2):CD00631818425946PubMedGoogle Scholar
10.
American Academy of Pediatrics Committee on Drugs.  Neonatal drug withdrawal.  Pediatrics. 1998;101(6):1079-1088Google Scholar
11.
Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants.  J Pediatr. 1991;118(6):933-9372040931PubMedGoogle ScholarCrossref
12.
O’Donnell M, Nassar N, Leonard H,  et al.  Increasing prevalence of neonatal withdrawal syndrome: population study of maternal factors and child protection involvement.  Pediatrics. 2009;123(4):e614-e62119336352PubMedGoogle ScholarCrossref
13.
Overview of the Kids' Inpatient Database (KID).  Healthcare Cost and Utilization Project (HCUP): 2000, 2003, 2006, 2009. http://www.hcup-us.ahrq.gov/kidoverview.jsp. Accessed April 6, 2012
14.
Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM. Inpatient health care utilization for children dependent on long-term mechanical ventilation.  Pediatrics. 2011;127(6):e1533-e154121576303PubMedGoogle ScholarCrossref
15.
Zickafoose JS, Benneyworth BD, Riebschleger MP, Espinosa CM, Davis MM. Hospitalizations for intussusception before and after the reintroduction of rotavirus vaccine in the United States.  Arch Pediatr Adolesc Med. 2012;166(4):350-35522213609PubMedGoogle ScholarCrossref
16.
Myrvik MP, Campbell AD, Davis MM, Butcher JL. Impact of psychiatric diagnoses on hospital length of stay in children with sickle cell anemia.  Pediatr Blood Cancer. 2012;58(2):239-24321425450PubMedGoogle ScholarCrossref
17.
Macy ML, Stanley RM, Sasson C, Gebremariam A, Davis MM. High turnover stays for pediatric asthma in the United States: analysis of the 2006 Kids' Inpatient Database.  Med Care. 2010;48(9):827-83320706158PubMedGoogle ScholarCrossref
18.
Odetola FO, Gebremariam A, Davis MM. Comorbid illnesses among critically ill hospitalized children: impact on hospital resource use and mortality, 1997-2006.  Pediatr Crit Care Med. 2010;11(4):457-46320595822PubMedGoogle Scholar
19.
Healthcare Cost and Utilization Project (HCUP).  Introduction to the KID: 2009, HCUP KID Related Reports. Rockville, MD: Agency for Healthcare Research and Quality; 2011
20.
Overview of the Nationwide Inpatient Sample (NIS).  Healthcare Cost and Utilization Project (HCUP): 2007-2009. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed April 6, 2012
21.
Healthcare Cost and Utilization Project (HCUP).  Introduction to the NIS: 2009, HCUP NIS Related Reports. Rockville, MD: Agency for Healthcare Research and Quality; 2011
22.
Kandall SR, Albin S, Lowinson J, Berle B, Eidelman AI, Gartner LM. Differential effects of maternal heroin and methadone use on birthweight.  Pediatrics. 1976;58(5):681-685980601PubMedGoogle Scholar
23.
Royston P. Multiple imputation of missing values: further update of ice, with an emphasis an categorical variables.  Stata Journal. 2009;9(3):466-477Google Scholar
24.
US Bureau of Labor Statistics.  2010 Consumer Price Index. http://www.bls.gov/cpi/. Accessed April 6, 2012
25.
Weisberg S. Applied linear regression. 3rd ed. In: Wiley Series in Probability and Statistics. Hoboken, NJ: Wiley-Interscience; 2005
26.
Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes.  Am J Obstet Gynecol. 2011;204(3):259.e1-259.e421376165PubMedGoogle ScholarCrossref
27.
Signs V.Centers for Disease Control and Prevention (CDC).  Vital signs: overdoses of prescription opioid pain relievers—United States, 1999-2008.  MMWR Morb Mortal Wkly Rep. 2011;60(43):1487-149222048730PubMedGoogle Scholar
28.
Centers for Disease Control and Prevention (CDC).  Drug overdose deaths—Florida, 2003-2009.  MMWR Morb Mortal Wkly Rep. 2011;60(26):869-87221734633PubMedGoogle Scholar
29.
 Prescription Drug Abuse. CS/CS/HB 227 (Fla 2012). http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=47335. Accessed April 6, 2012
30.
US General Accounting Office.  Drug-Exposed Infants: A Generation at Risk. Washington, DC: US General Accounting Office; 1990
31.
Backes CH, Backes CR, Gardner D, Nankervis CA, Giannone PJ, Cordero L. Neonatal abstinence syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting.  J Perinatol. 2011;21852772PubMedGoogle Scholar
32.
Burns L, Mattick RP. Using population data to examine the prevalence and correlates of neonatal abstinence syndrome.  Drug Alcohol Rev. 2007;26(5):487-49217701511PubMedGoogle ScholarCrossref
33.
Agthe AG, Kim GR, Mathias KB,  et al.  Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial.  Pediatrics. 2009;123(5):e849-e85619398463PubMedGoogle ScholarCrossref
34.
Kaltenbach K, Berghella V, Finnegan L. Opioid dependence during pregnancy: effects and management.  Obstet Gynecol Clin North Am. 1998;25(1):139-1519547764PubMedGoogle ScholarCrossref
35.
Jones HE, O’Grady KE, Malfi D, Tuten M. Methadone maintenance vs. methadone taper during pregnancy: maternal and neonatal outcomes.  Am J Addict. 2008;17(5):372-38618770079PubMedGoogle ScholarCrossref
36.
Almario CV, Seligman NS, Dysart KC, Berghella V, Baxter JK. Risk factors for preterm birth among opiate-addicted gravid women in a methadone treatment program.  Am J Obstet Gynecol. 2009;201(3):326.e1-326.e619631928PubMedGoogle ScholarCrossref
37.
Brown HL, Britton KA, Mahaffey D, Brizendine E, Hiett AK, Turnquest MA. Methadone maintenance in pregnancy: a reappraisal.  Am J Obstet Gynecol. 1998;179(2):459-4639731853PubMedGoogle ScholarCrossref
38.
Jones HE, Kaltenbach K, Heil SH,  et al.  Neonatal abstinence syndrome after methadone or buprenorphine exposure.  N Engl J Med. 2010;363(24):2320-233121142534PubMedGoogle ScholarCrossref
39.
Arlettaz R, Kashiwagi M, Das-Kundu S, Fauchère JC, Lang A, Bucher HU. Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources.  Acta Obstet Gynecol Scand. 2005;84(2):145-15015683374PubMedGoogle Scholar
40.
Osborn DA, Jeffery HE, Cole MJ. Sedatives for opiate withdrawal in newborn infants.  Cochrane Database Syst Rev. 2010;(10):CD00205320927729PubMedGoogle Scholar
41.
Sarkar S, Donn SM. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey.  J Perinatol. 2006;26(1):15-1716355103PubMedGoogle ScholarCrossref
42.
Coyle MG, Ferguson A, Lagasse L, Oh W, Lester B. Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants.  J Pediatr. 2002;140(5):561-56412032522PubMedGoogle ScholarCrossref
43.
Jansson LM, Velez M, Harrow C. Methadone maintenance and lactation: a review of the literature and current management guidelines.  J Hum Lact. 2004;20(1):62-7114974702PubMedGoogle ScholarCrossref
44.
Wachman EM, Byun J, Philipp BL. Breastfeeding rates among mothers of infants with neonatal abstinence syndrome.  Breastfeed Med. 2010;5(4):159-16420658895PubMedGoogle ScholarCrossref
45.
Saiki T, Lee S, Hannam S, Greenough A. Neonatal abstinence syndrome: postnatal ward versus neonatal unit management.  Eur J Pediatr. 2010;169(1):95-9819440732PubMedGoogle ScholarCrossref
Original Contribution
ONLINE FIRST
May 9, 2012

Neonatal Abstinence Syndrome and Associated Health Care Expenditures: United States, 2000-2009

Author Affiliations

Author Affiliations: Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor (Drs Patrick, Schumacher, Benneyworth, McAllister, and Davis); Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan Health System, Ann Arbor (Drs Patrick and Davis); Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Krans); and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor (Dr Davis).

JAMA. 2012;307(18):1934-1940. doi:10.1001/jama.2012.3951
Abstract

Context Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome primarily caused by maternal opiate use. No national estimates are available for the incidence of maternal opiate use at the time of delivery or NAS.

Objectives To determine the national incidence of NAS and antepartum maternal opiate use and to characterize trends in national health care expenditures associated with NAS between 2000 and 2009.

Design, Setting, and Patients A retrospective, serial, cross-sectional analysis of a nationally representative sample of newborns with NAS. The Kids' Inpatient Database (KID) was used to identify newborns with NAS by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. The Nationwide Inpatient Sample (NIS) was used to identify mothers using diagnosis related groups for vaginal and cesarean deliveries. Clinical conditions were identified using ICD-9-CM diagnosis codes. NAS and maternal opiate use were described as an annual frequency per 1000 hospital births. Missing hospital charges (<5% of cases) were estimated using multiple imputation. Trends in health care utilization outcomes over time were evaluated using variance-weighted regression. All hospital charges were adjusted for inflation to 2009 US dollars.

Main Outcome Measures Incidence of NAS and maternal opiate use, and related hospital charges.

Results The separate years (2000, 2003, 2006, and 2009) of national discharge data included 2920 to 9674 unweighted discharges with NAS and 987 to 4563 unweighted discharges for mothers diagnosed with antepartum opiate use, within data sets including 784 191 to 1.1 million discharges for children (KID) and 816 554 to 879 910 discharges for all ages of delivering mothers (NIS). Between 2000 and 2009, the incidence of NAS among newborns increased from 1.20 (95% CI, 1.04-1.37) to 3.39 (95% CI, 3.12-3.67) per 1000 hospital births per year (P for trend < .001). Antepartum maternal opiate use also increased from 1.19 (95% CI, 1.01-1.35) to 5.63 (95% CI, 4.40-6.71) per 1000 hospital births per year (P for trend < .001). In 2009, newborns with NAS were more likely than all other hospital births to have low birthweight (19.1%; SE, 0.5%; vs 7.0%; SE, 0.2%), have respiratory complications (30.9%; SE, 0.7%; vs 8.9%; SE, 0.1%), and be covered by Medicaid (78.1%; SE, 0.8%; vs 45.5%; SE, 0.7%; all P < .001). Mean hospital charges for discharges with NAS increased from $39 400 (95% CI, $33 400-$45 400) in 2000 to $53 400 (95% CI, $49 000-$57 700) in 2009 (P for trend < .001). By 2009, 77.6% of charges for NAS were attributed to state Medicaid programs.

Conclusion Between 2000 and 2009, a substantial increase in the incidence of NAS and maternal opiate use in the United States was observed, as well as hospital charges related to NAS.

×