January 27, 2017
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Neonatal abstinence syndrome rates increase significantly in rural areas

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The prevalence of neonatal abstinence syndrome has increased disproportionately in rural areas compared to urban areas during the past decade, according to a research letter published in JAMA Pediatrics.

“Incidence rates for neonatal abstinence syndrome (NAS) and maternal opioid use increased nearly [fivefold] in the United States between 2000 and 2012,” Nicole L.G. Villapiano, MD, MSc, from Robert Wood Johnson Foundation Clinical Scholars Program at the University of Michigan, and colleagues wrote in the research letter. “To our knowledge, no study has examined national trends in NAS and maternal opioid use among rural patients compared with their urban counterparts.”

The researchers used data from the National Inpatient Sample to assess neonatal births and obstetric deliveries from 2004 to 2013. They compared the rates of infants born with NAS and maternal opioid use in rural areas with their urban counterparts.

Villapiano and colleagues discovered that the incidence of newborns diagnosed with NAS in rural areas increased from 1.2 (95% CI, 0.9-1.6) case per 1,000 hospital births from 2003-2004 to 7.5 (95% CI, 6.6-8.3) from 2012-2013. In comparison, the incidence of infants born with NAS in urban areas increased from 1.4 (95% CI, 1.2-1.7) to 4.8 (95% CI, 4.5-5) during the same period. Researchers saw the overall proportion of infants diagnosed with NAS increased from 12.9% to 21.2% in rural communities (P < .001).

They further observed that the frequency of hospital deliveries complicated by maternal opioid use also increased from 1.3 (95% CI, 1-1.6) per 1,000 deliveries in 2003-2004 to 8.1 (95% CI, 7.3-8.9) in 2012-2013 among rural mothers, while the increase among urban mothers was 1.6 (95% CI, 1.3-1.9) to 4.8 (95% CI, 4.5-5.1) during the same period.

The incidence of NAS and maternal opioid use in the United States increased disproportionately in rural counties from 2004 to 2013 relative to urban counties,” Villapiano and colleagues wrote. “This geographic disparity highlights the urgent need for policymakers to appropriate funding for clinicians and programs that could improve access to opioid prevention and treatment services for rural women and children. by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.