From the Journals

Interventions urged to stop rising NAS, stem Medicaid costs


Key clinical point: The ever increasing NAS incidence and corresponding Medicaid costs require interventions focused on stopping opioid use by low-income mothers.

Major finding: In 2011-2014, mean hospital costs for NAS infants covered by Medicaid were more than fivefold higher than for infants without NAS ($19,340/birth vs. $3,700/birth).

Study details: A serial cross-sectional analysis that usd data from the 2004-2014 National Inpatient Sample (NIS) of 9,115,457 birth discharge records.

Disclosures: Stephen W. Patrick, MD, was supported by an award from the National Institute on Drug Abuse. None of the other authors had relevant financial disclosures.

Source: Winkelman TNA et al. Pediatrics. 2018;141(4):e20173520.



The incidence of neonatal abstinence syndrome (NAS) and the corresponding costs to Medicaid are unlikely to decline unless interventions focus on stopping opioid use by low-income mothers, said Tyler N.A. Winkelman, MD, of Hennepin County Medical Center, Minneapolis, and his associates.

Newborn baby sleeping in an incubator Zoonar RF/Thinkstock
NAS refers to a group of conditions experienced by infants exposed to opioids in utero as withdrawal shortly after birth. They may have tremors, irritability, poor feeding, respiratory distress, and seizures. As the opioid epidemic has worsened across the United States, the incidence of NAS has correspondingly surged.‍

Dr. Winkelman and his associates conducted a serial cross-sectional analysis that used 9,115,457 birth discharge records from the 2004-2014 National Inpatient Sample (NIS), which were representative of 43.6 million weighted births. Overall, 3,991,336 infants were covered by Medicaid, which were representative of 19.1 million weighted births. There were 35,629 (0.89%) infants with a diagnosis of NAS, which were representative of 173,384 weighted births. Medicaid was the primary payer for 74% (95% confidence interval, 68.9%-77.9%) of NAS-related births in 2004 and 82% (95% CI, 80.5%-83.5%) of NAS-related births in 2014.

Infants with NAS who were enrolled in Medicaid were significantly more likely to be male, live in a rural county, and have comorbidities reflective of the syndrome than were infants without NAS who were enrolled in Medicaid, the researchers wrote in Pediatrics.

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