Snapshot

More infants suffering from withdrawal

Not only did the number of infants with neonatal abstinence syndrome increase dramatically from 2004 to 2013, but the proportion of NICU days devoted to caring for those infants increased to 4% in 2013 from just 0.6% in 2004, according to a study in the New England Journal of Medicine.


A dramatic increase of infants undergoing drug withdrawal seems to have caught the medical world off-guard, according to a study in the New England Journal of Medicine.

In 2004, neonatal abstinence syndrome occurred in 7 out of every 1,000 babies admitted to a neonatal intensive care unit (NICU). By 2013, that number had more than tripled, to 27 out of 1,000.

Admissions for neonatal abstinence syndrome

Number per 1,000 admissions

Not only did the number of infants with neonatal abstinence syndrome increase, the proportion of NICU days devoted to caring for those infants increased to 4% in 2013 from just 0.6% in 2004, according to this study.

NICU days attributable to neonatal abstinence syndrome

Percentage of total NICU days

Costs almost certainly shot up as well. Although this particular study didn’t crunch the numbers, the total annual cost for caring for such infants is almost $1 billion and shows signs of increasing, according to Alan R. Spitzer, MD, the senior author of the study and a vice president at Mednax, a publicly traded company that provides neonatology and other hospital services.

Researchers looked at multiple cross-sectional analyses and deidentified data in nearly 300 NICUs in the United States. Information included whether the mothers smoked, abused substances, and what specific medications they may have used during pregnancy.

Neonatal abstinence syndrome occurs most often after in utero exposure to opioids. Signs and symptoms include irritability, hypertonia, impaired weight gain, and sometimes seizures. Whether there are long-term effects is uncertain.

The diagnosis is usually made through use of a standardized scale that scores the infant on the presence and severity of common withdrawal symptoms, the study states.

Strong evidence from clinical trials about how to best treat neonatal abstinence syndrome is lacking, so physicians depend on their clinical judgment and the results of small studies.

Spitzer and his colleagues found that the use of morphine has increased, so that by 2013 almost 3 out of 4 infants with neonatal abstinence syndrome were treated with the drug. The use of clonidine has also gone up while the use of methadone has decreased.

Medication use in infants with neonatal abstinence syndrome

Medication use (% of infants)

Source: Tolia VN et al., New England Journal of Medicine, April 26, 2015

The data used to conduct this study came from the documentation and billing software used by Pediatrix, an operating unit of Mednax. The authors say the data encompasses about 20% of the infants admitted to NICUs in the United States.

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