Cases of neonatal abstinence syndrome (NAS) increased 3-fold in the United States from 2000 to 2009, with some indication that the problem may be worse in rural areas. The purpose of our study was to report the incidence of NAS in a small rural community with a regional referral hospital and describe aspects of these infants’ NICU stay.
Using maternal prenatal positive urine drug screens (UDS) as our initial focus, deliveries at 35 weeks or beyond between March 2015 and May 2016 were included. NAS severity score, length of NICU stay, and hospital charges for each infant were obtained from chart review.
Thirty three of 981 infants developed NAS requiring NICU admission. Most of these were not identified by either a prenatal history or a routine first prenatal visit UDS. For the 7 infants who were identified as at risk by a positive UDS early in pregnancy, the average length of stay in the NICU was 10 days, the average NAS score was 8, and the average NICU charge was $46,000 compared to $3,440 charge for a term normal newborn.
Many studies have shown that neonatal abstinence syndrome is becoming more common, and some suggest that it may be a bigger problem in rural areas. While prenatal UDS may be helpful, many exposed infants will be missed. Even when exposure is proven, without reasonable access to medication assisted treatment during pregnancy, the outcome may still be unfavorable. The precise prevalence and cost in rural hospitals that serve as regional referral centers are needed for adequate health service planning. This planning includes strategies to increase local access to treatment options for pregnant women dependent on opioids.
Conflict(s) of Interest
References with DOI
1. Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology. 2015 35(8), 650-655. doi: 10.1038/jp.2015.36. Erratum in: Journal of Perinatology. 2015 35(8):667. Lehman, C U [corrected to Lehmann, C U]. https://doi.org/10.1038/jp.2015.36
2. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. Journal of the American Medical Association. 2012 307(18):1934-1940. doi: 10.1001/jama.2012.3951. https://doi.org/10.1097/01.aoa.0000429117.48176.cc
3. Stabler ME, Long DL, Chertok IR, Giacobbi PR Jr., Pilkerton C, Lander LR. (2016). Neonatal Abstinence Syndrome in West Virginia substate regions, 2007-2013. Journal of Rural Health. 2017 33(1):92-101. doi: 10.1111/jrh.12174. https://doi.org/10.1111/jrh.12174
4. Kremer ME, Arora KS. Clinical, ethical, and legal considerations in pregnant women with opioid abuse. Obstetrics & Gynecology. 2015 126(3);474-478. doi: 10.1097/AOG.0000000000000991. https://doi.org/10.1097/aog.0000000000000991
5. Kaltenbach K, Jones HE. Neonatal Abstinence Syndrome: presentation and treatment considerations. Journal of Addiction Medicine. 2016 10(4);217-223. doi: 10.1097/ADM.0000000000000207. https://doi.org/10.1097/adm.0000000000000207
6. Ordean A, Kahan M, Graves L, Abrahams R, Kim T. Obstetrical and neonatal outcomes of methadonemaintained pregnant women: a Canadian multisite cohort study. Journal of Obstetrics and Gynaecology Canada. 2015 37(3):252-257. https://doi.org/10.1016/s1701-2163(15)30311-x
7. Warren MD, Miller AM, Traylor J, Bauer A, Patrick SW. Centers for Disease Control and Prevention (CDC). Implementation of a statewide surveillance system for neonatal abstinence syndrome - Tennessee, 2013. Morbidity and Mortality Weekly Report. 2015 64(5):125-128.
8. Ailes EC, Dawson AL, Lind JN, Gilboa SM, Frey MT, Broussard CS, et al. Centers for Disease Control and Prevention (CDC). Opioid prescription claims among women of reproductive age--United States, 2008-2012. Morbidity and Mortality Weekly Report. 2015 64(2):37-41.
Fazenbaker Crowell, Sydni; Crump-Rogers, Allison M.; Crump, William; and Langston, LeAnn
"The Impact of Neonatal Abstinence Syndrome: The View from a Rural Kentucky Hospital,"
Marshall Journal of Medicine:
3, Article 10.
Available at: http://mds.marshall.edu/mjm/vol3/iss3/10