Healthcare Costs Associated with Neonatal Abstinence Syndrome

Recent data indicate that 16.2% of pregnant teens and 7.4% of pregnant women 18 to 25 years of age use illicit drugs. The newborn babies of those mothers may experience neonatal abstinence syndrome (NAS), a drug withdrawal syndrome, following birth. NAS occurs most commonly in babies whose mothers used illicit opiates, however, other drugs have been implicated as well.

Symptoms of NAS include increased irritability, hypertonia, tremors, feeding intolerance, emesis, watery stools, seizures, and respiratory distress? issues?. These symptoms have been identified in 60% to 80% of newborns exposed to heroin or methadone in utero.

Noting that there are no national estimates of the incidence of NAS over time in the context of maternal opiate use at the time of delivery, researchers recently designed an examination of patterns in the national incidence of NAS and maternal opiate use at the time of delivery. A secondary objective was to describe clinical comorbidites and utilization of health services patterns for NAS. They reported results of their analysis online in the Journal of the American Medical Association [doi:10.1001/jama.2012.3951].

The retrospective, serial, cross-sectional analysis utilized the Kids’ Inpatient Database to identify newborns with NAS by International Classification of Diseases, Ninth Revision, Clinical Modification code. The National Inpatient Sample, developed by the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project, was used to identify characteristics of maternal deliveries associated with substance abuse.

In 2000, the rate of NAS diagnosed in newborns was 1.20 (95% confidence interval [CI], 1.04-1.37) per 1000 hospital births per year; in 2009, the rate of NAS diagnosed in newborns was 3.39 (95% CI, 3.12-3.67) per 1000 hospital births per year (P<.001 for trend). During the same time period, the rate of antepartum maternal opiate use 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 <.001 for trend).

Newborns with NAS were significantly more likely to have respiratory diagnoses (30.9%), low birth weight (19.1%), feeding difficulties (18.1%), and seizures (2.3%), compared with all other hospital births. NAS newborns were also more likely to be covered by Medicaid (78.1%) and reside in zip codes within the lowest income quartile (36.3%), compared with all other hospital births.

Mean hospital charges for newborns diagnosed with NAS increased from $39,400 in 2000 to $53,400 in 2009, an increase of 35% (P<.001 for trend). Charges for all other hospital births increased from $6600 in 2000 to $9500 in 2009, an increase of 30% (P<.001 for trend).

Length of stay (LOS) remained unchanged for newborns with NAS (approximately 16 days; P=.06 for trend), compared with a slightly increasing LOS for all other hospital births during the study period (approximately 3 days; P<.001 for trend).

Adjusted for inflation, total hospital charges for NAS are estimated to have increased from $190 million to $720 million between 2000 and 2009 (P<.001 for trend). The estimated number of newborns with NAS in the United States was 13,359 in 2009 (approximately 1 infant per hour with signs of drug withdrawal).

In conclusion, the researchers said, “Newborns with NAS experience longer, often medically complex and costly initial hospitalizations. The increasing incidence of NAS and its related healthcare expenditures call for increased public health measures to reduce the antenatal exposure to opiates across the United States…States are poised to seek innovative solutions to decreasing the burden of NAS, because the majority of hospital expenditures for this condition are shouldered by state Medicaid programs.”