Neonatal Abstinence Syndrome and Associated Health Care Expenditures

A RECENT NATIONAL STUDY indicated that illicit drug use is 16.2% among pregnant teens and 7.4% among pregnant women aged 18 to 25 years. Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome in newborns following birth. The syndrome most commonly occurs in the context of antepartum opiate use, although other drugs have also been implicated. In addition to NAS, illicit drug use (specifically opioid dependence) during pregnancy is associated with a signi f icant ly increased risk of adverse neonatal outcomes such as low birthweight ( 2500 g) and mortality. Neonatal abstinence syndrome is characterized by a wide array of signs and symptoms including increased irritability, hypertonia, tremors, feeding intolerance, emesis, watery stools, seizures, and respiratory distress. Symptoms of withdrawal associated with NAS have been described in 60% to 80% of newborns exposed to heroin or methadone in utero. Recently, analyses from Australia and the Florida Medicaid program (D. Aronberg, JD, written communication, November 30, 2011) found that the incidence of NAS has been increasing. To date, there are no national esAuthor Affiliations are listed at the end of this article. Corresponding Author: Stephen W. Patrick, MD, MPH, MS, University of Michigan Health System, 6312 Medical Science Bldg 1, 1150 W Medical Center Dr, SPC 5604, Ann Arbor, MI 48109-5604 (stepatri@med .umich.edu). Context Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome primarily caused by maternal opiate use. No national estimates are available for the incidence of maternal opiate use at the time of delivery or NAS.