751 - Rate of Neonatal Abstinence Syndrome and pattern of acute care resource utilization in Alberta, Canada

Publication Number: 751.6138

Dinesh Dharel, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Nona Lailan, Alberta Health Services, Calgary, AB, Canada; Deborah A. McNeil, Alberta Health Services, Calgary, BC, Canada; Seija Kromm, Alberta Health Services, Calgary, AB, Canada; Brett A. Simms, Alberta Health Services, Calgary, AB, Canada; Matt Hicks, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada

Background: The increasing burden of Neonatal Abstinence Syndrome (NAS) depicts a huge societal cost on top of the neurobiological harm to infants resulting from Canada’s increasing opioid crisis. The Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) project is implementing a province-wide hospital-level transition from a traditional to a ‘rooming-in’ model of care for infants with NAS in Alberta.

Objective: To describe the trends in NAS rate and pattern of acute care length of stay (LOS), emergency department (ED) visits, and readmission within 30 days of discharge from NAS hospitalization in Alberta from 2012 to 2023.

Design/Methods: This retrospective descriptive study used data collected for the Provincial NAS Dashboard. We included NAS episodes based on ICD-10 codes P96.1 or P04.4 extracted from the Canadian Institute for Health Information Discharge Abstract Database (DAD) from 1 January 2012 to 31 December 2023. NAS rate is based on all NAS episodes aggregated monthly per 1000 live births in Alberta. For infants born at ≥35 weeks gestation, we calculated the acute care length of stay from the first diagnosis of NAS to discharge home, stratified to neonatal intensive care unit (NICU) or non-NICU beds, and presented in days with 95% confidence interval (CI). We used the rate of all-cause ED visits (extracted from the National Ambulatory Care Reporting System) and readmission to any acute care units (extracted from DAD) by day seven and day thirty of discharge home as a proxy to post-discharge acute-care resource utilization for NAS care.

Results: The average NAS rate from 2012 to 2023 is 4.98 per 1000 live births in Alberta. Annual NAS rates were higher than average in the years 2016 to 2021. NICU admission was required for 64% of NAS episodes (n=3122): 57% among term (n=2122) and 78% among 35-36 weeks gestation (n=487). Average LOS was 18.3 days (95% CI: 15.2,21.4) in NICU and 6.2 days (95% CI: 3.1,7.2) in non-NICU beds. NICU LOS was comparable for term (15.9 days) and 35-36 weeks infants (15.6 days). The 7- and 30-day readmission rates post discharge were higher for 35-36 weeks gestation compared to term infants but the rate of ED visits by day 7 of discharge was comparable.

Conclusion(s): The trends in NAS rates and patterns of length of hospital stay as well as ED visit and readmission rates for Albertan infants with NAS in the last twelve years illustrate the fluctuating scenarios of NAS care in the province and provide signals to further explore variations in acute care resource utilization that would inform tailored programming during and after the ongoing prospective Alberta NASCENT study.

Rate of Neonatal Abstinence Syndrome and proportion of NICU admissions in Alberta from 2012 to 2023
Rate of Neonatal Abstinence Syndrome (NAS) per 1000 live births in Alberta from 2012 to 2023 (in line chart) and the percentage of Neonatal Intensive Care Unit (NICU) admissions (in bar diagram)

Length of acute care hospitalization for NAS care in Alberta from 2012-2023 stratified by gestational age
Length of acute care hospitalization for Neonatal Abstinence Syndrome (NAS) care in days (with error bars representing 95% confidence interval bounds) for infants born at 35-36 weeks and ≥ 37 weeks gestation from 2012-2023 in Alberta (bars represent annual and line chart represents overall average days of hospital stay)

All cause emergency department visit and hospital readmission by day 7 and day 30 of discharge from index hospitalization for infants with neonatal abstinence syndrome from 2012 to 2023 in Alberta
Rates of emergency department (ED) visits and hospital readmission by day 7 and day 30 of discharge from index hospitalization for infants with neonatal abstinence syndrome born at ≥35 weeks gestation from 2012 to 2023 in Alberta (bars representing annual average rates and line chart representing overall average rates)

Rate of Neonatal Abstinence Syndrome and proportion of NICU admissions in Alberta from 2012 to 2023
Rate of Neonatal Abstinence Syndrome (NAS) per 1000 live births in Alberta from 2012 to 2023 (in line chart) and the percentage of Neonatal Intensive Care Unit (NICU) admissions (in bar diagram)

Length of acute care hospitalization for NAS care in Alberta from 2012-2023 stratified by gestational age
Length of acute care hospitalization for Neonatal Abstinence Syndrome (NAS) care in days (with error bars representing 95% confidence interval bounds) for infants born at 35-36 weeks and ≥ 37 weeks gestation from 2012-2023 in Alberta (bars represent annual and line chart represents overall average days of hospital stay)

All cause emergency department visit and hospital readmission by day 7 and day 30 of discharge from index hospitalization for infants with neonatal abstinence syndrome from 2012 to 2023 in Alberta
Rates of emergency department (ED) visits and hospital readmission by day 7 and day 30 of discharge from index hospitalization for infants with neonatal abstinence syndrome born at ≥35 weeks gestation from 2012 to 2023 in Alberta (bars representing annual average rates and line chart representing overall average rates)