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Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome that occurs among opioid-exposed infants shortly after birth. NAS is associated with poor fetal growth and preterm birth, and can cause symptoms such as seizures, excessive irritability, poor feeding, and dehydration.

Definition and Impact of NAS

Neonatal abstinence syndrome refers to the collection of signs and symptoms that occur when a newborn prenatally exposed to prescribed, diverted, or illicit opiates experiences opioid withdrawal. Symptoms of NAS include: irritability, tremors, feeding problems, vomiting, diarrhea, sweating, and, in some cases, seizures.

In addition to the direct symptoms of NAS, infants with NAS are more likely to experience other adverse outcomes and complications at birth, including: low birth weight, respiratory problems, jaundice, feeding difficulties, seizures, and sepsis.

Infants born in Illinois with NAS have longer hospital stays and higher hospital charges than infants without NAS.

  • In 2016, the median length of hospital stay after birth was 11 days longer for infants with NAS compared to infants without NAS.
  • In 2016, the median charges for the birth hospitalization of infants with NAS were approximately $33,700, compared to approximately $4,400 for infants without NAS.
  • In 2016, the total charges for the hospital care of infants born with NAS were nearly $18 million higher than what would have been expected if they had been born without NAS.

Relationship to Maternal Opioid Use

Several studies from Tennessee provide information demonstrating the link between maternal opioid use and NAS.

  • A study of Tennessee Medicaid-enrolled pregnant women found that 28% filled at least one prescription for an opioid pain reliever during pregnancy.
  • Among Tennessee women with no prescribed opioids, 0.5% had infants who developed NAS. If a woman was prescribed any short-acting, long-acting, or maintenance opioids during pregnancy, the percent of infants with NAS respectively increased to 1.4%, 14.7%, and 29.3%.
  • A study of Tennessee infants diagnosed with NAS showed that 42% of cases involved only prescribed maternal use of opioids during pregnancy, 33% involved only maternal use of illicit/diverted opioids, and 22% involved maternal use of both prescribed and diverted/illicit use of opioids.

Data

  • In 2016, the rate of NAS in Illinois was about 2.7 NAS cases per 1,000 live births, affecting 391 infants born in Illinois that year.
  • The NAS rate is highest among: Non-Hispanic White infants, infants covered by public insurance (Medicaid) or who are uninsured, and infants residing in urban counties outside the Chicago metropolitan area.

Image source: /content/dam/soi/en/web/idph/files/images/nasrate-2016-birth-042018.png

There was a 52% increase in the Illinois NAS rate between 2011 and 2016.

Image source: /content/dam/soi/en/web/idph/files/images/nasrate-2016-infant-042018.png

The rise in NAS rates is different across geography of the state. Between 2011-2016, NAS rates increased by: 27% in the Collar counties, 137% in urban counties outside the Chicago area, and 223% in rural counties. In comparison, the NAS rates decreased by 9% in Chicago and increased by only 2% in suburban Cook County during this time period.

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