title: Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome.
abstract: OBJECTIVE
  Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS.
  
  
  METHODS
  Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1,018,421 live born infants without an NAS diagnosis.
  
  
  RESULTS
  Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poisoning (3.6, 2.6-4.8), and mental/behavioral (2.6, 2.1-3.2) and visual (2.9, 2.5-3.5) disorders. Mothers of infants with NAS were more likely to be Indigenous (6.4, 6.0-7.0), have no antenatal care (6.6, 5.9-7.4), and be socioeconomically deprived (1.6, 1.5-1.7). Regression analyses demonstrated that NAS was the most important predictor of admissions for maltreatment (odds ratio 4.5, 95% confidence interval: 3.4-6.1) and mental and behavioral disorders (2.3, 1.9-2.9), even after accounting for prematurity, maternal age, and Indigenous status.
  
  
  CONCLUSIONS
  Children with NAS are more likely to be rehospitalized during childhood for maltreatment, trauma, and mental and behavioral disorders even after accounting for prematurity. This continues to adolescence and emphasizes the critical need for continued support of this vulnerable group after resolution of NAS.
authors.affiliation: School of Women's and Children's Heath, University of New South Wales, Kensington, Australia;
authors.forename: Hannah
authors.initials: H
authors.lastname: Uebel
authors.affiliation: Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, Australia; Department of Paediatrics, The Wollongong Hospital, Wollongong, Australia;
authors.forename: Ian M
authors.initials: IM
authors.lastname: Wright
authors.affiliation: National Drug and Alcohol Research Centre, and.
authors.forename: Lucy
authors.initials: L
authors.lastname: Burns
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, Australia;
authors.forename: Lisa
authors.initials: L
authors.lastname: Hilder
authors.affiliation: NSW Pregnancy and Newborn Services Network;
authors.forename: Barbara
authors.initials: B
authors.lastname: Bajuk
authors.affiliation: National Drug and Alcohol Research Centre, and.
authors.forename: Courtney
authors.initials: C
authors.lastname: Breen
authors.affiliation: Department of Neonatology, The Canberra Hospital, Garran, Australia; Faculty of Medicine, Australian National University, Deakin, Australia;
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abdel-Latif
authors.affiliation: School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Sydney Children's Hospital, Randwick, Australia;
authors.forename: John M
authors.initials: JM
authors.lastname: Feller
authors.affiliation: The Langton Centre, Surry Hills, Australia;
authors.forename: Janet
authors.initials: J
authors.lastname: Falconer
authors.affiliation: The Langton Centre, Surry Hills, Australia;
authors.forename: Sarah
authors.initials: S
authors.lastname: Clews
authors.affiliation: School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Sydney Local Health District, Australia; School of Public Health, University of Sydney, Camperdown, Australia; and.
authors.forename: John
authors.initials: J
authors.lastname: Eastwood
authors.affiliation: School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Department of Newborn Care, Royal Hospital for Women, Randwick, Australia j.oei@unsw.edu.au.
authors.forename: Ju Lee
authors.initials: JL
authors.lastname: Oei
mesh_terms: D000328:Adult; D001315:Australia; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009357:Neonatal Abstinence Syndrome / Q000150:complications*; D009517:New South Wales; D009293:Opioid-Related Disorders / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D012044:Regression Analysis