Mahmoud Ali, West Virginia University Children's Hospital, Morgantown, WV, United States; Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Hatem Eltaly, Cleveland Clinic Children's, Cleveland, OH, United States; Leen I. I.. Sabbooba, Cleveland Clinic Children's, Fairview park, Cleveland, OH, United States; Hany Aly, Cleveland Children’s Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States
Assistant professor pediatrics - NICU West Virginia university Morgantown, West Virginia, United States
Background: Neonatal abstinence syndrome (NAS) has been a challenging national epidemic in recent years, linked to dependence on medication, longer hospital stays, and higher healthcare costs. However, other adverse outcomes such as increased vulnerability to infections or liver dysfunction have not been well described. Objective: To examine the prevalence of blood stream infection (BSI), urinary tract infection (UTI), liver dysfunction such as cholestasis, and their impact on LOS in infants with NAS. Design/Methods: This analysis used the National Inpatient Sample (NIS) dataset from the Healthcare Cost and Utilization Project (HCUP). Newborn infants were identified using the International Classification of Diseases-Version 10 (ICD10). The ICD10 codes P96.1, P39.3, and P78.89, were used to identify infants with NAS, UTI, and cholestasis, respectively. The ICD10 codes P36.0, P36,1, 'P36.10, P36.19, P36.2, P36.3, P36.30, P36.39, P36.4, P36.5, P36.8, P36.9, and P37.2 were used to identify BSI or sepsis. Infants weighing less than 1500 grams or born before 32 weeks, as well as those with CNS, lung, gastrointestinal, or multiple congenital anomalies, congenital heart disease, congenital diaphragmatic hernia, or chromosomal disorders, were excluded due to their independent association with the adverse outcomes of interest. Results: The study sample included 18,070,987 infants, 48.7% females, 46.5% Caucasians, 97.3% singleton, and 1.64% small for gestational age (SGA) infants. There were 132,769 (0.73%) infants diagnosed with NAS, 165981 (0.92%) with BSI, 19,702 (0.11%) with UTI, and 6700 (0.04%) with cholestasis. There were 2.84% infants with BSI in infants with NAS vs. 0.90% in infants without NAS, aOR 3.38 (95% CI: 3.27-3.49), p < 0.001. There were 0.28% infants with UTI in NAS infants vs. 0.11% in non-NAS infants, aOR 2.89 (2.61-3.21), p < 0.001. There were 0.15% infants with cholestasis in NAS infants vs. 0.04% in non-NAS infants, aOR 4.31 (3.74-4.96), p < 0.001. Although, the LOS of infants with NAS is significantly higher than those without NAS, 10d vs. 2d, p < 0.001, the presence of any of the above complications further increased the LOS. LOS in infant with NAS complicated with BSI, UTI, or cholestasis was 15d (p < 0.001), 26d (p < 0.001), and 20d (p < 0.001), respectively
Conclusion(s): The burden of NAS extends beyond prolonged medication and hospital stays; it significantly correlates with severe outcomes like infection risk, UTIs, and liver dysfunction, all of which increase hospital length of stay and medical costs. Qualitative analysis is needed to explore the biological plausibility of these associations.
