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

Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI 48109-5604, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2012; 307(18):1934-40. DOI: 10.1001/jama.2012.3951
Source: PubMed


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

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

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    • "jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y scheme to ensure national representativeness [26]. Besides collecting patient-related and provider-related data, the NIS utilizes the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to standardise the reporting of up to 25 (15 prior to 2009) diagnoses and 15 procedures. "
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    • "Between 2000 and 2009, antepartum opioid use increased from 1.19 to 5.63 per 1000 live births in the United States. Concurrently, the incidence of neonatal abstinence syndrome (NAS) increased from 1.20 to 3.39 per 1000 live births, and related hospitalization costs increased from $39,400 to $53,400 per infant with NAS [1]. NAS is characterized by gastrointestinal, respiratory, autonomic, and central nervous system disturbances from opioid withdrawal that affect critical regulatory areas of postnatal life adaptation [2]. "
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