Babies born with opioid withdrawal disproportionately increasing in rural areas
by Craig Boerner
An increasing number of newborns are being born with drug withdrawal symptoms from opioids in rural areas of the United States as compared to births in urban areas, according to a JAMA Pediatrics study.
The study, led by researchers from Monroe Carell Jr. Children’s Hospital at Vanderbilt, the University of Michigan C.S. Mott Children’s Hospital and the University of Minnesota, tracked newborns treated for opioid-related issues over 10 years.
Newborns diagnosed with neonatal abstinence syndrome (NAS) due to their withdrawal symptoms increased from nearly one case per 1,000 births in rural areas from 2003-2004 to 7.5 cases per 1,000 births from 2012-2013, nearly 80 percent higher than the growth rate of such cases in urban areas.
Senior author Stephen Patrick, M.D., MPH, M.S., assistant professor of Pediatrics and Health Policy at Vanderbilt University Medical Center, said the results highlight a dramatic and disproportionate rise in opioid-related complications for these patients in rural communities.
“As a nation, there is an urgent need to develop strategies tailored to rural communities focused on prevention and expansion of treatment,” Patrick said.
“We need to develop means to support rural hospitals, especially critical access hospitals, that are on the front lines in providing care for mothers and infants impacted by the opioid epidemic,” he said.
NAS patients are more likely to have respiratory complications, low birth-weight, feeding difficulty and seizures as compared to other infants.
“The opioid epidemic has hit rural communities especially hard and we found that these geographical disparities also affect pregnant women and infants,” said lead author and Mott pediatrician Nicole Villapiano, M.D.
“Our study highlights an urgent need to fund providers and programs that will help improve access to opioid prevention and treatment services for rural women and children. Maternal opioid use requires special attention given the poor outcomes and high costs. If we can provide resources to the areas that need them the most, we can do more on the frontlines to address the opioid crisis for our most vulnerable patients.”
Rural infants accounted for more than 21 percent of NAS cases from 2012-2013, up from 13 percent in 2003-2004.
Maternal opioid use in rural areas was also nearly 70 percent higher than in urban areas in 2012-2013, with 8 cases per 1,000 childbirth hospitalizations compared to 4.8 cases per 1,000 childbirth hospitalizations in urban areas.
Rural infants and mothers with opioid-related diagnoses were more likely to be from lower-income families, have public insurance and be transferred to another hospital following delivery.
Villapiano noted that families in urban areas typically have wider access to treatment and addiction services that can help affected babies have better outcomes.
“We need to consider what kind of support moms with opioid disorders have in rural communities,” she said.
source: Vanderbilt University · Nashville, Tennessee