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Neonatal Abstinence Syndrome Increases Among Rural Infants

The JAMA Network Journals

The proportion of infants with neonatal abstinence syndrome - the resulting complications and withdrawal symptoms when infants are no longer exposed to maternal opioids - increased in rural counties in the United States in the last decade, according to a new research letter published online by JAMA Pediatrics.

Nicole L.G. Villapiano, M.D., M.Sc., of the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Michigan, Ann Arbor, and coauthors used data from the National Inpatient Sample for neonatal births and obstetric deliveries between 2004 and 2013.

The proportion of infants diagnosed with neonatal abstinence syndrome (NAS) who were from rural counties increased from 12.9 percent to 21.2 percent, according to the results.

Additionally, the authors report that from 2004 to 2013 the incidence of NAS increased from 1.2 to 7.5 per 1,000 hospital births among rural infants and from 1.4 to 4.8 per 1,000 hospital births among urban infants.

The frequency of hospital deliveries complicated by maternal opioid use increased during the same period from 1.3 to 8.1 per 1,000 hospital deliveries among rural mothers and from 1.6 to 4.8 per 1,000 hospital deliveries among urban mothers, according to the results.

While the authors acknowledge their analysis may reflect changes in coding practices and increased awareness of opioid-related complications, they suggest that was unlikely to account for the disparities between the rural and urban areas.

"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," the research letter concludes.

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(JAMA Pediatr. Published online December 12, 2016. doi:10.1001/jamapediatrics.2016.3750; available pre-embargo at the For The Media website.)

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