Assessing the Health and Financial Burden of Neonatal Abstinence Syndrome Among All Payer Inpatient Pediatric Discharges in Nevada

Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome among neonates born to drug-dependent mothers. NAS poses a significant health and fiscal challenge nationally, with its incidence increasing by a factor of six (1.20 to 6.7 per 1,000 hospital births/year) along with the concomitant rise in health care cost from 2000-2016. Besides national data, it is critical to quantify NAS at the state-level to identify the target areas for prevention. Given the higher opioid prescribing rates among pregnant women in Nevada, it is critical to assess the health and financial magnitude of NAS in the state. The objectives of this cross-sectional study were to describe the burden of NAS in Nevada from 2016 to 2018, including incidence, hospital utilization trends and cost, and differences across demographic and clinical characteristics between newborns with and without a NAS diagnosis. This study utilized hospital administrative data from the Center for Health Information Analysis. The units of observation were in-patient pediatric discharges with a diagnostic code of NAS following maternal drug abuse. Statistical analyses included estimation of crude incidence rates per 1,000 hospital births, bootstrapped significance testing for independent-samples t-tests and chi-square tests, and multilevel logistic regression modelling. Results demonstrated an increase in overall NAS incidence of 8 per 1,000 hospital births, with disproportionate effects in certain demographic groups. The incidence of NAS was the highest among white newborns (12 per 1,000 hospital births) and those who were Medicaid insured (13.2 per 1,000 hospital births). NAS infants were more likely to experience other clinical conditions, longer hospital stays (mean length of stay 17 days), incur higher health care costs, and undergo intense medical procedures. NAS has taken a heavy toll on Nevada’s health care system with over 75% of the total cost attributed to state Medicaid programs. These findings support the need for targeted interventions in clinical and public health settings aimed at prevention and burden reduction of NAS in Nevada