Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013

TLDR

Neonatal abstinence syndrome, a postnatal withdrawal syndrome in opioid‑exposed infants characterized by CNS irritability, autonomic overreactivity, and gastrointestinal dysfunction, has risen sharply in the United States since 2000, yet state‑level incidence data remain scarce. The CDC analyzed state‑level trends in NAS incidence by extracting all‑payer hospital inpatient delivery discharge records from the HCUP State Inpatient Databases for 1999–2013. Across 28 states, NAS incidence increased 300 % from 1.5 to 6.0 per 1,000 hospital births, with 25 of 27 states showing significant rises and 2013 rates ranging from 0.7 to 33.4 per 1,000 births, highlighting the need for targeted state public‑health interventions.

Abstract

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction (1). During 2000-2012, the incidence of NAS in the United States significantly increased (2,3). Several recent publications have provided national estimates of NAS (2,3); however, data describing incidence at the state level are limited. CDC examined state trends in NAS incidence using all-payer, hospital inpatient delivery discharges compiled in the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) during 1999-2013. Among 28 states with publicly available data in HCUP during 1999-2013, the overall NAS incidence increased 300%, from 1.5 per 1,000 hospital births in 1999, to 6.0 per 1,000 hospital births in 2013. During the study period, significant increases in NAS incidence occurred in 25 of 27 states with at least 3 years of data, with annual incidence rate changes ranging from 0.05 (Hawaii) to 3.6 (Vermont) per 1,000 births. In 2013, NAS incidence ranged from 0.7 cases per 1,000 hospital births (Hawaii) to 33.4 cases per 1,000 hospital births (West Virginia). The findings underscore the importance of state-based public health programs to prevent unnecessary opioid use and to treat substance use disorders during pregnancy, as well as decrease the incidence of NAS.