Significant increase in rural babies born with opioid withdrawal

By Liz Meszaros, MDLinx
Published December 14, 2016

Key Takeaways

Since 2003, the incidence of babies born in opioid withdrawal significantly increased in rural communities, and is higher than that of infants born in urban locations, according to results from a study published in JAMA Pediatrics.  

Over a span of 10 years, researchers from the University of Michigan C.S. Mott Children’s Hospital and Monroe Carell Jr. Children’s Hospital, Vanderbilt University, Nashville, TN, tracked newborns treated for opioid-related complications. They found that, from 2003 to 2004 the rate of newborns diagnosed with neonatal abstinence syndrome was nearly 1 case per 1,000 births. By 2012-2013, this rate had skyrocketed to 7.5 case per 1,000 births.

“The opioid epidemic has hit rural communities especially hard and we found that these geographical disparities also affect pregnant women and infants,” says lead author Nicole Villapiano, MD, MSc, pediatrician, C.S. Mott Children’s Hospital.

“Our study highlights an urgent need to fund providers and programs that will help improve access to opioid prevention and treatment services for rural women and children. Maternal opioid use requires special attention given the poor outcomes and high costs. If we can provide resources to the areas that need them the most, we can do more on the frontlines to address the opioid crisis for our most vulnerable patients.”

Dr. Villapiano and colleagues used data from the National Inpatient Sample to identify all neonatal births and obstetric deliveries between 2004 and 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification code 779.5 in any diagnosis field, they identified all infants with neonatal abstinence syndrome (NAS), excluding those of potentially iatrogenic NAS. They also identified maternal opioid use, using ICD 9 Clinical Modification codes 304.0x, 304.7x, or 305.5x.

Using the National Center for Health Statistics Classification Scheme for Counties, these researchers defined the location of the infant/mother residences as rural or urban. Then, according to subjects' rural or urban status, they classified demographics and calculated the proportion of NAS cases in infants for each 2-year period, as well as the incidence rates of NAS and maternal opioid use according to rural or urban status for these 2-year periods.

They found that compared to urban infants and mothers with opioid-related diagnoses, those in rural locations were more likely to be from lower-income families, receive public insurance, and be transferred to another hospital after delivery.

Urban dwelling families often have wider access to treatment and addiction services, which may cause better outcomes in infants who are affected, noted Dr. Villapiano.

“We need to consider what kind of support moms with opioid disorders have in rural communities,” she noted.

Dr. Villapiano and fellow researchers also found that the proportion of infants with NAS from rural counties increased from 12.9% in 2003-2004 to 21.2% in 2012-2013 (P < 0.001). In addition, from 2004 to 2013, they observed an increase in the incidence of NAS from 1.2 (95% CI, 0.9-1.6) to 7.5 (95% CI, 6.6-8,3) per 1000 hospital births in urban infants.

During this same time, the frequency of hospital deliveries complicated by maternal opioid use increased from 1.3 (95% CI, 1.0-1.6) to 8.1 (95% CI, 7.3-8.9) per 1000 hospital deliveries among rural mothers, and from 1.6 (95% CI, 1.3-1.9) to 4.8 (95% CI, 4.5-5.1) per 1000 hospital deliveries in urban mothers.

“As a nation, there is an urgent need to develop strategies tailored to rural communities focused on prevention and expansion of treatment,” said senior author Stephen W. Patrick, MD, MPH, MS, assistant professor of pediatrics and health policy, Vanderbilt University.

“We need to develop means to support rural hospitals, especially critical access hospitals, that are on the front lines in providing care for mothers and infants impacted by the opioid epidemic,” he concluded.

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