Neonatal abstinence syndrome in a small rural state, 2006-2011

Background

According to the American College of Obstetricians and Gynecologists (ACOG), Neonatal abstinence syndrome (NAS) is an expected and treatable condition that follows prenatal exposure to opioids.   NAS is of growing concern, nationally and in Vermont. Population health surveillance of NAS (primarily from medical claims hospital discharge data) is limited.   

Methods

We used the Vermont Unified Hospital Discharge Dataset (VUHDDS) to analyze NAS cases among live births in Vermont.  Linear regression was used to evaluate discharge rates since 2006.  Analyses were limited to live births of Vermont residents at Vermont hospitals because of Vermont’s porous border.  We performed preliminary qualitative analyses of programmatic changes that impact diagnosis and awareness of NAS as well as changes that impact access to treatment. 

Results

NAS discharges among live births of Vermont residents have significantly increased at a rate of nearly four births per year from 2006 through 2011 (p<.05).   In the last 10 years, there has been a campaign to increase awareness of NAS among providers and we have seen nearly twice as many women enter treatment for opiate abuse.

Conclusions

Recent research using hospital discharge data shows an overall increase nationally, 3.4 per 1,000 live births in 2009.  The rise of newborns diagnosed with NAS in Vermont is 7-fold higher than the U.S. average.  The rise and the disparity could be explained by provider awareness, increased access to medication assisted therapy and opioid addiction treatment, and discrepancies and changes in coding practices.