Uebel Hannah, Wright Ian M, Burns Lucy, Hilder Lisa, Bajuk Barbara, Breen Courtney, Abdel-Latif Mohamed E, Ward Meredith, Eastwood John, Feller John M, Falconer Janet, Clews Sara, Oei Ju Lee
School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia.
Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.
Paediatr Perinat Epidemiol. 2016 May;30(3):267-73. doi: 10.1111/ppe.12282. Epub 2016 Feb 5.
This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically defined population in Australia.
Database linkage analysis of all births between 2000 and 2011 in New South Wales (NSW), Australia. The diagnosis of NAS was derived from hospital coding P96.1, 'Neonatal withdrawal symptoms from maternal use of drugs of addiction'. Temporal trends were studied by comparing epoch 1 (2000-05) with epoch 2 (2006-11). The relationship with changes in maternal factors was further analysed.
The NAS was coded in 3842 of 1 022 263 live born infants (0.38%). NAS incidence peaked at 5.07 per 1000 live births in 2002, decreasing to 3.18 in 2011 and was negatively correlated with maternal age (r = -0.7). The rate of NAS in epoch 2 (3.4 per 1000 births, 95% CI 3.28, 3.58) was significantly lower than in epoch 1 (4.1 per 1000 births, 95% CI 3.96, 4.33). Epoch 2 mothers were significantly older (mean 29.8 years vs. 28.3 years), less likely to be multiparous (OR 0.7, 95% CI 0.6, 0.9) or smoke (OR 0.4, 95% CI 0.4, 0.5). They were more likely to engage in antenatal care earlier (mean first visit: 14.1 vs. 18.9 weeks). Most infants (~80%) were born at term (>37 weeks gestation).
The incidence of NAS as a discharge diagnosis has decreased in our population since 2002. Mothers are also older and engaging earlier in prenatal care. Whether these changes alter NAS presentation and diagnosis or whether pregnant women are using drugs that do not cause typical NAS (e.g. amphetamines) is uncertain and requires further study.
本研究分析了澳大利亚一个地理区域界定明确的大型人群中新生儿戒断综合征（NAS）的发病率。
对澳大利亚新南威尔士州（NSW）2000年至2011年期间的所有出生记录进行数据库关联分析。NAS的诊断源自医院编码P96.1，即“母亲使用成瘾药物导致的新生儿戒断症状”。通过比较阶段1（2000 - 2005年）和阶段2（2006 - 2011年）研究时间趋势。进一步分析其与母亲因素变化的关系。
在1022263例活产婴儿中，有3842例被编码为NAS（0.38%）。NAS发病率在2002年达到每1000例活产5.07的峰值，2011年降至3.18，且与母亲年龄呈负相关（r = -0.7）。阶段2的NAS发病率（每1000例出生3.4例，95%可信区间3.28，3.58）显著低于阶段1（每1000例出生4.1例，95%可信区间3.96，4.33）。阶段2的母亲年龄显著更大（平均29.8岁对28.3岁），多胎妊娠的可能性更低（比值比0.7，95%可信区间0.6，0.9）或吸烟的可能性更低（比值比0.4，95%可信区间0.4，0.5）。她们更早开始进行产前检查的可能性更大（平均首次就诊时间：14.1周对18.9周）。大多数婴儿（约80%）足月出生（妊娠>37周）。
自2002年以来，我们人群中作为出院诊断的NAS发病率有所下降。母亲年龄也更大，且更早开始进行产前检查。这些变化是否改变了NAS的表现和诊断方式，或者孕妇是否正在使用不会导致典型NAS的药物（如苯丙胺）尚不确定，需要进一步研究。
