The Journal of the Arkansas Medical Society Med Journal Feb 2019 Final 2 | Page 14

SCIENTIFIC ARTICLE
Neonatal Abstinence Syndrome in Arkansas
Jonathan Aram, MPH 1 ; Alan Mease, MD 2 ; Taniesha Richardson-Wiley, MPH 3 ; Betty Bohanna 4 ; Jessica Coker, MD 5
1
Epidemiologist, Arkansas Department of Health
2
Medical Director of Child & Adolescent Health, Arkansas Department of Health
3
Hospital Discharge Data, Section Chief, Arkansas Department of Health
4
Hospital Discharge Data, Sr. Statistical/Research Analyst, Arkansas Department of Health
5
Assistant Professor, Department of Psychiatry, UAMS
Abstract
N
eonatal abstinence syn-
drome (NAS) is a constella-
tion of symptoms that result
from in-utero exposure to drugs. We
used the Arkansas Hospital Discharge Da-
tabase to analyze NAS diagnoses in terms
of person, place, and time. We found a large
increase in NAS diagnoses between 2000
and 2014 and large differences between
demographic groups. We then used the
Arkansas Prescription Monitoring Program
(PMP) to estimate per the capita opioid pre-
scribing to women of reproductive age. We
found that starting with those aged 25-29,
one or more opioid prescriptions were writ-
ten per capita to Arkansas women in 2014.
Background Methods
Neonatal abstinence syndrome (NAS) is a
set of symptoms consistent with dysfunctional
regulation of the central and autonomous ner-
vous systems that occur in newborns who are
exposed to psychoactive drugs while in the
mother’s womb. 1 Hospital discharge data pro-
vides a broad overview of NAS diagnoses in Ar-
kansas. The Arkansas Hospital Discharge Data-
base contains a record of all patients discharged
from inpatient acute care hospitals in Arkansas.
The database includes demographic informa-
tion and up to 18 different diagnoses for each
patient. Estimates of prescription opioid use, a
risk factor for NAS, can be made using the Ar-
kansas Prescription Monitoring Program (PMP).
The PMP contains a record of all controlled sub-
stances dispensed by Arkansas pharmacies. In
addition to drug name, day supply, and quantity
dispensed, the PMP also collects patient demo-
graphic information, like age and sex. We searched all hospital discharge records
from 2000 – 2014 (n = 6,245,596) to identify
births (International Classification of Disease,
Ninth Revision, Clinical Modification (ICD-9-CM)
codes V30.x-V39.X ending in 00 or 01) and cases
of NAS (ICD-9-CM code 779.5). Cases were then
grouped based on race, ethnicity, and insurance
type. Median length of stay and median charges
were calculated for babies diagnosed with NAS
and babies not diagnosed with NAS. Patient ad-
dress was used to calculate NAS diagnoses per
1,000 live births at the county level.
We used the PMP to estimate opioids pre-
scribed to women of reproductive age per capita
in 2014. We included in our analysis all pre-
scriptions for oral opioid analgesic tablets. We
excluded opioids used for the treatment of sub-
stance use disorders, like Suboxone © , as well as
patches and liquids. The number of prescriptions
filled was divided by population estimates from
Figure 1. Rate of Neonatal Abstinence Syndrome Per 1,000 Hospital Births, Arkansas Residents, 2000-2014*
*Does not include births to
Arkansas mothers occurring in
out-of-state hospitals
Source: ADH Hospital Discharge
Data System
182 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 115