Using big data to help the tiniest patients

The study results are reported in a paper authored by a Baylor researcher and published online by the New England Journal of Medicine. The illness, called "neonatal abstinence syndrome" (NAS), is a drug withdrawal syndrome that most commonly occurs after in utero exposure to opioids. It can lead to seizures, difficulty feeding, respiratory complications and low-birth-weight in affected infants.

The study published by the NEJM, titled "Increasing Incidence of the Neonatal Abstinence Syndrome in U.S. Neonatal ICUs," directly addressed the ICU care of these infants and found that NAS is responsible for a substantial and growing portion of resources dedicated to critically ill neonates in NICUs nationwide.

Dr. Veeral N. Tolia, a neonatologist on staff at Baylor University Medical Center at Dallas, led a team of researchers from U.S. hospitals that determined that between 2004 and 2013 the rate of NICU admissions nationwide for NAS increased almost fourfold, from seven to 27 cases per 1000 infants. The research also found that the length of hospitalization increased by more than 40 percent from 13 to 19 days. The total percentage of NICU days attributed to NAS increased by more than 500 percent, with eight centers reporting one in five of all NICU days devoted to care of these infants in 2013.

The team also found that a substantial number of these infants presented after maternal exposure to prescription opioid pain relievers, a class of medication that the Food and Drug Administration (FDA) recently has chosen to regulate more tightly. The study found that among these NICU patients, treatment with medication was common, occurring in 87 percent of the infants from 2012-2013.

This is also problematic because of the scarce research about the best way to care for these infants. None of the commonly used medications are FDA approved for treating NAS and there is substantial variability in how these infants are treated.