Incidence of neonatal abstinence syndrome, or NAS, among infants in rural areas increased more than 500% from 2004 to 2013 -- far outpacing growth among infants in urban areas, said researchers.

Neonatal abstinence syndrome in rural areas rose from 1.2 per 1,000 (95% CI 0.9-1.6) hospital births to 7.5 per 1,000 (95% CI 6.6-8.3), while NAS was up from 1.4 per 1,000 (95% CI 1.2-1.7) to 4.8 per 1,000 (95% CI 4.5-5.0) in urban areas, reported Nicole L.G. Villapiano, MD, of the University of Michigan, and colleagues.

Writing in a research letter in JAMA Pediatrics, the authors said they saw similar results when examining the frequency of hospital deliveries that were complicated by maternal opioid use in rural and urban areas during the same time period (from 1.3 to 8.1 per 1,000 hospital births and from 1.6 to 4.8 per 1,000 hospital births, respectively).

In 2012-2013, infants in rural areas comprised 21.2% of all infants with neonatal abstinence syndrome -- a significant increase from 2003-2004, when they only comprised 12.9% (P<0.001). Rural infants and mothers were also more likely to be from low-income families, have public insurance, and be transferred to another hospital following delivery versus infants and mothers from urban areas.



The authors examined data from the National Inpatient Sample, which measures hospital discharges around the country. Rural or urban areas were defined by the National Center for Health Statistics Classification Scheme for Counties.
Asked for her opinion, Dessa Bergen-Cico, PhD, of Syracuse University, said that this data also mirrors that of New York state -- where incidence of neonatal abstinence syndrome was higher in central New York than in New York City in 2012.

"Prevention, harm reduction, and treatment is grossly underfunded and virtually unavailable in rural communities," Bergen-Cico told MedPage Today. "I live in a rural area of central New York and I have been finding discarded needles along the roadside for the past 6 years. There are little to no clean needle distribution centers or needle collection facilities in rural areas, yet opioid use is quite prevalent and overdose deaths occur regularly."

These findings were also similar to CDC data released earlier this year, which found significant increases in NAS for 25 of 27 states.

The authors cited this geographic disparity as a call to action for policymakers "to appropriate funding for clinicians and programs that could improve access" to treatment programs for women and children in rural areas. They suggested strategies such as increasing access to buprenorphine distribution and programs to help treat women and children affected by opioid use.

Bergen-Cico agreed, adding that the best way to prevent increasing rates of neonatal abstinence syndrome may be to target opioid addiction.

"It is not medically recommended for a pregnant woman to stop using heroin or opioids if she is physically addicted because it is too stressful on the baby. We have to develop new and innovative means of reaching people in our rural communities abusing opioids," she said.