From the Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Pediatrix Medical Group (V.N.T.), and the Office of the Chief Quality Officer, Baylor Scott and White Health (M.M.B.) - all in Dallas; the Mildred Stahlman Division of Neonatology, Department of Pediatrics, and the Vanderbilt Center for Health Services Research and Department of Health Policy, Vanderbilt University School of Medicine, Nashville (S.W.P.); the Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann and Robert H. Lurie Children's Hospital of Chicago - both in Chicago (K.M.); the Department of Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton (J.S.), and the Center for Research, Education, and Quality, Mednax, Sunrise (R.H.C., A.R.S.) - both in Florida; the Department of Pediatrics, Duke University School of Medicine, Durham, NC (P.B.S.); and Pediatrix Medical Group, Greenville Memorial Hospital, Greenville, SC (R.H.C.).
N Engl J Med. 2015 May 28;372(22):2118-26. doi: 10.1056/NEJMsa1500439. Epub 2015 Apr 26.
The incidence of the neonatal abstinence syndrome, a drug-withdrawal syndrome that most commonly occurs after in utero exposure to opioids, is known to have increased during the past decade. However, recent trends in the incidence of the syndrome and changes in demographic characteristics and hospital treatment of these infants have not been well characterized.
Using multiple cross-sectional analyses and a deidentified data set, we analyzed data from infants with the neonatal abstinence syndrome from 2004 through 2013 in 299 neonatal intensive care units (NICUs) across the United States. We evaluated trends in incidence and health care utilization and changes in infant and maternal clinical characteristics.
Among 674,845 infants admitted to NICUs, we identified 10,327 with the neonatal abstinence syndrome. From 2004 through 2013, the rate of NICU admissions for the neonatal abstinence syndrome increased from 7 cases per 1000 admissions to 27 cases per 1000 admissions; the median length of stay increased from 13 days to 19 days (P<0.001 for both trends). The total percentage of NICU days nationwide that were attributed to the neonatal abstinence syndrome increased from 0.6% to 4.0% (P<0.001 for trend), with eight centers reporting that more than 20% of all NICU days were attributed to the care of these infants in 2013. Infants increasingly received pharmacotherapy (74% in 2004-2005 vs. 87% in 2012-2013, P<0.001 for trend), with morphine the most commonly used drug (49% in 2004 vs. 72% in 2013, P<0.001 for trend).
From 2004 through 2013, the neonatal abstinence syndrome was responsible for a substantial and growing portion of resources dedicated to critically ill neonates in NICUs nationwide.
新生儿戒断综合征是一种药物戒断综合征，最常见于胎儿在子宫内暴露于阿片类药物后，据知在过去十年中其发病率有所增加。然而，该综合征发病率的近期趋势以及这些婴儿的人口统计学特征和医院治疗的变化尚未得到很好的描述。
我们使用多次横断面分析和一个匿名数据集，分析了 2004 年至 2013 年期间全美 299 个新生儿重症监护病房（NICU）中患有新生儿戒断综合征的婴儿的数据。我们评估了发病率和医疗利用率的趋势以及婴儿和产妇临床特征的变化。
在入住 NICU 的 674845 名婴儿中，我们发现有 10327 名患有新生儿戒断综合征。从 2004 年到 2013 年，NICU 因新生儿戒断综合征的入院率从每 1000 例入院 7 例增加到每 1000 例入院 27 例；中位数住院时间从 13 天增加到 19 天（两种趋势均 P<0.001）。全国 NICU 天数中归因于新生儿戒断综合征的比例从 0.6%增加到 4.0%（趋势 P<0.001），2013 年有 8 个中心报告称，超过 20%的 NICU 天数归因于这些婴儿的护理。婴儿越来越多地接受药物治疗（2004-2005 年为 74%，2012-2013 年为 87%，趋势 P<0.001），最常使用的药物是吗啡（2004 年为 49%，2013 年为 72%，趋势 P<0.001）。
从 2004 年到 2013 年，新生儿戒断综合征在美国全国的 NICU 中负责为重症新生儿提供大量且不断增加的资源。
