Nearly all of the infants with confirmed cases of neonatal abstinence syndrome identified in three Florida hospitals during a 2-year period had documented in utero opioid exposure. Yet only 10% of their mothers received or were referred for drug addiction rehabilitation or counseling at the time of their infants’ birth.
The findings, reported by Jennifer N. Lind, PharmD, from the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues in the March 6 issue of the Morbidity and Mortality Weekly Report, highlight the issue of opioid use in women of childbearing age and point to the need for preventive and rehabilitative interventions in this population, the authors write.
Neonatal abstinence syndrome (NAS), also called neonatal withdrawal syndrome, refers to a constellation of behavioral and physiologic signs and symptoms in newborns exposed in utero to addictive illegal or prescription drugs. Infants born with NAS typically have prolonged hospital stays, experience serious medical complications, and are costly to treat, the authors note.
The researchers sought to identify maternal and infant characteristics in confirmed cases of NAS in Florida, where the number of hospital discharges of NAS-diagnosed infants has increased more than 10-fold since 1995, far exceeding the threefold increase observed nationally.
Using Florida’s hospital inpatient discharge data, linked to birth and death certificates, the investigators identified three hospitals in two Florida counties with a high number of NAS births that were able to provide the necessary study data. From 2010 to 2011, a total of 242 infants with confirmed NAS were born in these hospitals. Of these, 99.6% of the infants were exposed to opioids in utero and 97.1% were admitted to an intensive care unit. Their mean length of stay was 26.1 days. The authors note that none of the infants died during their birth hospitalization. Most of the NAS infants (82.6%) were non-Hispanic white.
Medical record documentation of maternal drug use confirmed that 99.6% of the mothers used opioids during pregnancy. “Approximately 82% of mothers were reported as using one or more opioid such as oxycodone, morphine, hydrocodone, hydromorphone, tramadol, or meperidine; 59.9% as using methadone; and 3.7% as using buprenorphine,” the authors write. “Less than 1% of mothers were reported to have used heroin during pregnancy.”
Most of the mothers with NAS babies (86.8%) underwent urine toxicology screening. Although positive urine screen results were reported in 90.5% of these women, the researchers found medical record documentation for receipt or referral for drug addiction rehabilitation or counseling during the birth hospitalization for just 10.3% of mothers.
“The findings of this investigation underscore the important public health problem of NAS and add to current knowledge on the characteristics of these mothers and infants,” the authors write. They note that NAS is now a mandatory reportable condition in Florida. The findings also point to the need for interventions to increase community resources available to drug-abusing women of reproductive age, improve drug-addiction counseling and rehabilitation referral and documentation policies, and link women to these resources before or earlier in pregnancy.