The Increasing Rate of Neonatal Withdrawal

Published - Written by Rena Xu

When expecting mothers use opioids, their babies are exposed to the drugs in utero and, after birth, are at risk of withdrawal. The neonatal abstinence syndrome frequently necessitates admission to a Neonatal Intensive Care Unit (NICU) for treatment and monitoring. As the rate of opioid use among pregnant women has risen, the incidence of neonatal abstinence syndrome has increased, too, posing a growing medical and financial problem.

Just how big of a problem has it become? A recent study in NEJM looked at the rate of NICU admissions and average length of NICU stay for infants with neonatal abstinence syndrome. The study used data from 2004 to 2013 for nearly 300 neonatal intensive care units (NICUs), encompassing nearly 675,000 babies (two percent of whom had neonatal abstinence syndrome).

Over this period, there was a dramatic rise in the rate of NICU admissions for neonatal abstinence syndrome — from 7 cases to 27 cases per 1000 admissions. The median length of NICU stay also increased, from 13 days to 19 days. And the proportion of NICU days attributed to infants with neonatal abstinence syndrome increased nearly seven fold, from 0.6% to 4%.

Among mothers, there was an increase in the proportion of Caucasians (from 64% in 2004-05 to 73% in 2012-13) and corresponding decrease in the proportion of blacks and Hispanics. There were no significant changes in maternal age or the percentage of mothers receiving prenatal care.

Neonatal abstinence syndrome was first described in association with mothers who used illicit drugs, but more recently, the authors observe, these babies are being born to mothers taking opioid pain relievers. In 2012-2013, nearly a quarter of infants with neonatal abstinence syndrome had been exposed to opioid pain medications.

“Our data…are consistent with reports suggesting that the rising incidence of the neonatal abstinence syndrome is due in part to increasing opioid use among pregnant women, which is a component of the current epidemic of opioid use and abuse in the United States,” the authors write. “Our findings support the need for…approaches to reduce opioid use among pregnant women.”

And, although the study did not calculate the costs associated with the observed increase in frequency and duration of NICU admissions, the authors note: “These findings are especially worrisome in the context of the high costs of NICU care and of increasing inpatient costs for infants with the neonatal abstinence syndrome, in particular.”


In your practice, have you noticed changes in the incidence and/or management of neonatal abstinence syndrome?  What strategies have you found effective for managing opioid use among pregnant women and reducing the risk of neonatal abstinence syndrome?

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