Epidemiological trends in abuse and misuse of prescription opioids. Similarly, infants with NAS who were enrolled in Medicaid were more likely to live in poor and rural counties but were less likely to be diagnosed with a NAS-related comorbidity compared with infants with NAS enrolled in private insurance (Table 1). [5]: https://ascpjournal.biomedcentral.com/articles/10.1186/1940-0640-9-19 The economic burden of neonatal abstinence syndrome in the United States. Beginning in 2012, the NIS sampling frame changed to 20% of discharges from all US hospitals. Alternatively, rising NAS incidence may be because of an improved awareness and recognition of the clinical syndrome over time or iatrogenic cases of NAS not accounted for in our exclusion criteria. The cost of opioid use during pregnancy: A fourfold rise in US hospital admissions for neonatal abstinence syndrome from 2003 to 2012. Rising NAS incidence led to higher NAS-associated hospital costs over the study period, both in aggregate and as an overall proportion of birth-related costs for state Medicaid programs. Libby is also trained in Family Based Therapy (FBT) to work with children-young adults to treat eating disorders. METHODS: The 2016 Kids’ Inpatient Database, provided by the Healthcare Cost and Utilization Project and Agency for Healthcare Research and Quality and its partners, was used to identify patients with NAS in the United States. Similar analyses were conducted for total birth-related costs due to NAS among all-payers. Opiate use by U.S. mothers and increases in neonatal abstinence syndrome. The purpose of this subgroup analysis was to ultimately determine costs among infants whose care was financed by a health insurance entity, and thus, we did not examine NAS incidence among uninsured infants. Federal and state Medicaid program administrators have the opportunity to implement policies that promote prevention and treatment of NAS. Medicaid was the primary payer for 73.7% (95% CI, 68.9%–77.9%) of NAS-related births in 2004 and 82.0% (95% CI, 80.5%–83.5%) of NAS-related births in 2014. NAS is a substance withdrawal syndrome occurring in infants after utero exposure to opioids or other substances. Symptoms of NAS may begin as soon as 24 to 48 hours after birth. United States Government Accountability Office, Agency for Healthcare Research and Quality. Among infants covered by Medicaid, NAS incidence increased more than fivefold during our study period, from 2.8 per 1000 births (95% CI, 2.1–3.6) in 2004 to 14.4 per 1000 births (95% CI, 12.9–15.8) in 2014. To address the rise of NAS in Massachusetts and improve health outcomes and reduce costs, the Massachusetts Health Policy Commission (HPC) launched its $3 million Mother and Infant-Focused Neonatal Abstinence Syndrome Interventions (NAS Interventions) in 2016. Rural and urban differences in neonatal abstinence syndrome and maternal opioid use, 2004 to 2013. Total costs by other payers (ie, Medicaid, private, and all-payers) can be found in the Supplemental Information. We compared the rate of hospital transfer to another facility, mean length of stay, and mean cost of birth hospitalization among infants with NAS who were enrolled in Medicaid to infants without NAS who were enrolled in Medicaid and to infants with NAS who were enrolled in private insurance. Newborns with NAS traditionally receive care in neonatal intensive care units (NICUs), but rooming-in with mother and family has been proposed to reduce the use of pharmacotherapy, length of stay (LOS), and cost. The Treatment of Neonatal Abstinence Syndrome. A recent analysis of the extent, context, and costs of NAS/NOWS found that incidence of NAS/NOWS is rising in the United States. Mean inflation-adjusted hospital costs for infants with NAS covered by Medicaid increased 26% between 2004 and 2006 and 2011 and 2014 ($15 350 vs $19 340; P < .001; Table 2). In each time period we examined, infants with NAS who were covered by Medicaid had hospital stays that were significantly longer than infants without NAS who were covered by Medicaid or infants with NAS who were covered by private insurance (Table 2). In adjusted analyses, infants with NAS who were covered by Medicaid were more likely to be transferred to another hospital for care (8.6% vs 7.1%; P = .02) and to have longer lengths of stay (16.5 days vs 14.6 days; P < .001) compared with infants with NAS who were covered by private insurance. Reviewed By: Jacquelyn Ekern, MS, LPC on January 29, 2017. In parallel, the U.S. experienced a substantial rise in diagnoses of neonatal abstinence syndrome, primarily from opioids, from 1.2 per 1,000 U.S. hospital births in 2000 to 8.8 per 1,000 in 2016 (Leech AA, et al. Medical treatments for NAS typically cost $150,000 per child, and in 2015 the average overall cost for a newborn suffering from NAS was found to be between $159,000 and $238,000 [6]. Enter multiple addresses on separate lines or separate them with commas. Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health. In the U.S., a baby is born with symptoms of NAS every 15 minutes. The triple aim for neonatal abstinence syndrome. Babies who are born with neonatal abstinence syndrome are hospitalized for on average 22-24 days at a cost of $45,000 to $90,000 per baby. Ultimately, a public health approach that targets patient-, family-, and community-level factors will be necessary to prevent women from developing opioid use disorders.30 Individual level predictors of opioid use disorders include mental health disorders and preexisting substance use disorders.31 Screening, referral, and treatment for these conditions may reduce the incidence of opioid use disorders among reproductive-age women. To account for this sampling redesign, we applied trend weights provided by the Healthcare Cost and Utilization Project to allow for comparison across years. Systematic implementation of policies that support rooming-in, breastfeeding, swaddling, on-demand feeding schedules, and minimization of sleep disruption may reduce symptoms of NAS and reduce the duration of, or even eliminate the need for, pharmacologic treatment of NAS.16–22 Opportunities for improved newborn care and reduced costs exist even among infants who require pharmacologic treatment of the management of NAS. Infants with NAS who were enrolled in Medicaid were significantly more likely to be male, reside in a rural county, and have comorbidities reflective of the syndrome than infants without NAS who were enrolled in Medicaid. By 2014, 14.4 per 1000 hospital births (95% CI, 12.9–15.8), or 1.4% of all Medicaid-financed births, were affected by NAS. Characteristics and trends among births impacted by NAS were examined by using univariate statistics and logistic regression. Obstetrical and neonatal outcomes of methadone-maintained pregnant women: a Canadian multisite cohort study. Finally, we estimated excess costs among infants covered by Medicaid due to NAS over the course of our study period by multiplying the number of weighted NAS births in each time period by the average cost for a non-NAS birth who were covered by Medicaid and subtracting these values from aggregated hospital costs for infants with NAS who were covered by Medicaid. Methadone in pregnancy: treatment retention and neonatal outcomes. Neonatal abstinence syndrome—postnatal ward versus neonatal unit management. Education with parents while in hospital about NAS and comfort strategies with positive reinforcement and determining when the medical team needs to make pharmacological decisions [11]. Trends in opioid analgesic abuse and mortality in the United States. Infants with NAS were identified if ICD-9-CM code 779.5 was listed in any diagnosis field. Or Sign In to Email Alerts with your Email Address, Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004, Evaluating Definitions for Neonatal Abstinence Syndrome, It Is Time to ACT NOW to Improve Quality for Opioid-Exposed Infants, Prenatal Opioid Exposure Enhances Responsiveness to Future Drug Reward and Alters Sensitivity to Pain: A Review of Preclinical Models and Contributing Mechanisms, Well-Child Care Adherence After Intrauterine Opioid Exposure, An Update on the Burden of Neonatal Abstinence Syndrome in the United States, Improving the Child Welfare System to Respond to the Needs of Substance-Exposed Infants, Neonatal Abstinence Syndrome and Associated Neonatal and Maternal Mortality and Morbidity, The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome, Improving the Discharge Process for Opioid-Exposed Neonates. The neonatal abstinence syndrome refers to a postnatal opioid withdrawal syndrome that can occur in 55 to 94% of newborns whose mothers were addicted to or treated with opioids while pregnant. Proportion of birth-related hospital costs due to NAS among infants who were enrolled in Medicaid. Winkelman, MD, MSc, Hennepin County Medical Center, 701 Park Ave, S2.309, Minneapolis, MN 55415. Encouraging self-calming efforts, skin-to-skin contact, and individualized caregiving. Total hospital costs for NAS among infants who were enrolled in Medicaid. Also in this study, costs of treatment rose from $1.1 million in the first year, to $1.5 million in the second year, and $1.8 million in the third year. Although time estimates are different for each substance, most NAS symptoms last for about 7 to 10 days; however, some symptoms can persist for up to 6 months after birth. Most women were taking cannabis alone, but this substance may have adverse effects on fetal wellbeing. It is characterized by gastrointestinal, respiratory, autonomic, and central nervous system disturbances from opioid withdrawal that affect critical regulatory areas of postnatal life adaptation [4].