Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Stephen W Patrick, Sep 25, 2014
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The available evidence regarding axillary artery injury as a result of proximal humerus fracture consists of individual case reports or small series. This study used nationally representative data to determine the prevalence and predictors of axillary artery injury secondary to proximal humerus fracture, and to characterise its influence on inpatient mortality, length of stay, cost and discharge disposition. An estimated 388,676 inpatients with a proximal humerus fracture were identified in the Nationwide Inpatient Sample between 2002 and 2011, 331 with concomitant axillary artery injury (8.5 per 10,000). Multivariable regression modelling was used to identify independent predictors of axillary artery injury and to assess its relationship with inpatient outcomes. Factors associated with axillary artery injury were male sex (odds ratio (OR): 1.6, 95% confidence interval (CI): 1.2-2.0), atherosclerosis (OR: 3.7, 95% CI: 2.5-5.4), open fracture (OR: 2.9, 95% CI: 1.9-4.5) and the presence of concomitant injuries, including brachial plexus injury (OR: 109, 95% CI: 79-151), shoulder dislocation (OR: 3.4, 95% CI: 2.0-5.8), scapula fracture (OR: 3.4, 95% CI: 2.1-5.4) and rib fracture (OR: 2.5, 95% CI: 1.6-4.0). Axillary artery injury was associated with increased length of stay, costs and mortality, but it did not affect discharge disposition. Our study provides important baseline information regarding the epidemiology of axillary artery injury secondary to proximal humerus fracture. Prompt identification of at-risk patients upon admission might lead to improved diagnosis and management of this vascular injury. Prognostic level II. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Injury
  • Source
    • "This manuscript describes results of a systematic review of the published literature to estimate overall contraceptive use and examine method choice among women with opioid and other substance use disorders and is the first effort to do so, to our knowledge. While the studies included were published over an approximately 40-year period, the observation that opioids were by far the most commonly used drug make the results especially relevant to the present day, with opioid use at epidemic levels (Maxwell, 2011) and much attention focused on the adverse consequences and costs of infants exposed in utero (e.g.,Patrick et al., 2012). Recent data also clearly demonstrate that nearly all of these pregnancies are unintended (Black et al., 2012;Heil et al., 2011;Jones et al., 2011), underscoring the need to better understand contraceptive use and method choice among women with opioid and other substance use disorders. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To systematically review the literature on contraceptive use by women with opioid and other substance use disorders in order to estimate overall contraceptive use and to examine method choice given the alarmingly high rate of unintended pregnancy in this population. Pubmed (1948-2014) and PsycINFO (1806-2014) databases were searched for peer-reviewed journal articles using a systematic search strategy. Only articles published in English and reporting contraceptive use within samples of women with opioid and other substance use disorders were eligible for inclusion. Out of 580 abstracts reviewed, 105 articles were given full-text review, and 24 studies met the inclusion criteria. The majority (58%) of women in these studies reported using opioids, with much smaller percentages reporting alcohol and cocaine use. Across studies, contraceptive prevalence ranged widely, from 6%-83%, with a median of 55%. Results from a small subset of studies (N=6) suggest that women with opioid and other substance use disorders used contraception less often than non-drug-using comparison populations (56% vs. 81%, respectively). Regarding method choice, condoms were the most prevalent method, accounting for a median of 54% of contraceptives used, while use of more effective methods, especially implants and intrauterine devices (IUDs), was far less prevalent (7%). Women with opioid and other substance use disorders have an unmet need for contraception, especially for the most effective methods. Offering contraception services in conjunction with substance use treatment and promoting use of more effective methods could help meet this need and reduce unintended pregnancy in this population. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Apr 2015 · Preventive Medicine
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.
    Full-text · Article · Sep 2014 · Addiction science & clinical practice
Show more