Abstract
Background
Neonatal abstinence syndrome (NAS) is one of the consequences at birth affecting the newborn after discontinuation of prenatal drug exposure to mainly opioids. The objective of this study was to determine the extent of the problem in the state of West Virginia (WV) using a real-time statewide surveillance system.
Methods
Project WATCH is a surveillance tool that since 1998 collects data on all infants born in the state of WV. NAS surveillance item was added to the tool in October 2016. This study examined all births (N = 23,667) in WV from October to December 2017. The data from six WV birthing facilities were audited for 1 month to evaluate how well this tool was capturing NAS data using κ-statistics.
Results
The 2017 annual incidence rate of NAS was 51.3 per 1000 live births per year for all births and 50.6 per 1000 live births per year for WV residents only. The κ-coefficient between the hospital medical records and Project WATCH data was 0.74 (95% confidence interval: 0.66–0.82) for NAS.
Conclusion
The study provides justification to develop effective systems of care for the mother–infant dyad affected by substance use, especially targeting pregnant women in rural communities.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Kocherlakota, P. Neonatal abstinence syndrome. Pediatrics 134, e547–e561 (2014).
Convertino, I. et al. Neonatal adaptation issues after maternal exposure to prescription drugs: withdrawal syndromes and residual pharmacological effects. Drug Saf. 39, 903–924 (2016).
Logan, B. A., Brown, M. S. & Hayes, M. J. Neonatal abstinence syndrome: treatment and pediatric outcomes. Clin. Obstet. Gynecol. 56, 186–192 (2013).
McQueen, K. & Murphy-Oikonen, J. Neonatal abstinence syndrome. N. Engl. J. Med 375, 2468–2479 (2016).
Klinger, G. et al. Long-term outcome following selective serotonin reuptake inhibitor induced neonatal abstinence syndrome. J. Perinatol. 31, 615–620 (2011).
Oei, J. L. et al. Neonatal abstinence syndrome and high school performance. Pediatrics 139, e20162651 (2017).
Patrick, S. W. et al. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. JAMA 307, 1934–1940 (2012).
Patrick, S. W., Davis, M. M., Lehmann, C. U. & Cooper, W. O. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J. Perinatol. 35, 650–655 (2015).
Corr, T. E. & Hollenbeak, C. S. The economic burden of neonatal abstinence syndrome in the United States. Addiction 112, 1590–1599 (2017).
Ridic, G., Gleason, S. & Ridic, O. Comparisons of health care systems in the United States, Germany and Canada. Mater. Sociomed. 24, 112–120 (2012).
Villapiano, N. L., Winkelman, T. N., Kozhimannil, K. B., Davis, M. M. & Patrick, S. W. Rural and urban differences in neonatal abstinence syndrome and maternal opioid use, 2004 to 2013. JAMA Pediatr. 171, 194–196 (2017).
Brown, J. D., Goodin, A. J. & Talbert, J. C. Rural and appalachian disparities in neonatal abstinence syndrome incidence and access to opioid abuse treatment. J. Rural Health 34, 6–13 (2017).
Warren, M. D. et al. Implementation of a statewide surveillance system for neonatal abstinence syndrome—Tennessee, 2013. Morb. Mortal. Wkly Rep. 64, 125–128 (2015).
Kaiser Family Foundation. KFF Medicaid’s Role in West Virginia (Kaiser Family Foundation, Washington, 2018).
Griffith, B. N., Lovett, G. D., Pyle, D. N. & Miller, W. C. Self-rated health in rural Appalachia: health perceptions are incongruent with health status and health behaviors. BMC Public Health 11, 229 (2011).
Hedegaard, H., Warner, M. & Minino, A. M. Drug overdose deaths in the United States, 1999–2015. NCHS Data Brief 1–8 (2017).
Stitely, M. L., Calhoun, B., Maxwell, S., Nerhood, R. & Chaffin, D. Prevalence of drug use in pregnant West Virginia patients. W V Med. J. 106, 48–52 (2010).
Stabler, M. E. et al. Neonatal abstinence syndrome in West Virginia Substate Regions, 2007–2013. J. Rural Health 33, 92–101 (2017).
Ko, J. Y. et al. Incidence of neonatal abstinence syndrome—28 States, 1999–2013. Morb. Mortal. Wkly Rep. 65, 799–802 (2016).
Burns, L. & Mattick, R. P. Using population data to examine the prevalence and correlates of neonatal abstinence syndrome. Drug Alcohol Rev. 26, 487–492 (2007).
Traylor, J., Miller, A. & Warren, M. D. Evaluation of the web-based neonatal abstinence syndrome surveillance system in Tennessee. In Conference: 2014 Council of State and Territorial Epidemiologists Annual Conference (2014). https://www.wvdhhr.org/birthscore/.
Article 22B. Birth Score Program (1998). https://www.wvdhhr.org/birthscore/.
Mullett, M. D., Britton, C. M., John, C. & Hamilton, C. W. WV birth score: maternal smoking and drugs of abuse. W V Med. J. 106, 16–18, 20 (2010).
Zhang, Z., Infante, A., Meit, M. & English, N. An Analysis of Mental Health and Substance Abuse Disparities and Access to Treatment Services in the Appalachian Region. CHAPTER 2: Substance Use, Mental Disorders, and Access to Treatment Services in Household Surveys (2008).
The Governor’s Initiative on Substance Abuse (2017). http://governorssubstanceabusetaskforceswv.com.
SAMHSA 2016 State Reports From the 2014 National Survey on Drug Use and Health (NSDUH). https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2016-NSDUH.
ICD-10-CM Codes. (2018). https://www.icd10data.com/ICD10CM/Codes.
HIDTA 2017 High Intensity Drug Trafficking Areas Program (HIDTA), ONDCP. Available at https://www.dea.gov/ops/HIDTA_2017_map.pdf. Accessed on 21 Jan 2018.
Ko, J. Y. et al. CDC grand rounds: public health strategies to prevent neonatal abstinence syndrome. Morb. Mortal. Wkly Rep. 66, 242–245 (2017).
American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. Pediatrics 101,1079–1088 (1998).
Huybrechts, K. F. et al. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. BMJ 358, j3326 (2017).
Sarkar, S. & Donn, S. M. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J. Perinatol. 26, 15–17 (2006).
Acknowledgements
The West Virginia WATCH/Birth Score Program is funded under an agreement with the West Virginia Department of Health and Human Resources, Bureau for Public Health, Office of Maternal, Child, and Family Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Umer, A., Loudin, S., Maxwell, S. et al. Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience. Pediatr Res 85, 607–611 (2019). https://doi.org/10.1038/s41390-018-0172-z
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41390-018-0172-z
This article is cited by
-
Variations and similarities in neonatal abstinence syndrome care and management across tertiary care hospitals in West Virginia
Journal of Perinatology (2022)
-
Prevalence of alcohol use in late pregnancy
Pediatric Research (2020)
-
Addressing rural health disparities in neonatal abstinence syndrome: population-based surveillance and public policy
Pediatric Research (2019)
