Perinatal & Pediatric
Race/ethnicity disparities in U.S. prevalence of neonatal opioid withdrawal syndrome in neonates ≥35 weeks GA using dual ICD-10CM exposure and withdrawal codes Hannah Neuman* Hannah Neuman Keith A. Dookeran James Groh Marina Feffer Janine Y. Khan
Neonatal opioid withdrawal syndrome (NOWS), a subset of neonatal abstinence syndrome (NAS), is an opioid-specific withdrawal syndrome in neonates that occurs after in-utero exposure to opioids. While previous studies have looked at NOWS prevalence based on the single ICD-10CM code for withdrawal (P96.1), a recent CDC study suggests that use of ICD-10CM codes for exposure (P04.49) along with withdrawal diagnosis (P96.1) may be more sensitive for identifying NOWS, with dual exposure/withdrawal codes capturing newborns exhibiting NOWS symptoms, identified by the exposure code, who have not received a withdrawal diagnosis. Using cross-sectional data from 2016, 2019, and 2022 cycles of the U.S. all-payer Kid’s Inpatient Database (KID), part of the Healthcare Cost & Utilization Project (HCUP), weighted NOWS prevalence per 1,000 live births was estimated for neonates ≥35 weeks gestational age from in-hospital births, excluding iatrogenic cases, using both single and dual codes. Multivariable generalized linear regression models with predictive margins were used to estimate RDs and 95% CIs for select sociodemographic factors —sex, payer-type, ecologic income level, and hospital size, location/teaching status, and region— stratified by race/ethnicity (R/E) (Figure 1). Using dual codes, overall NOWS prevalence decreased from 2016 (25.55) to 2022 (14.30). While the prevalence of NOWS for White (25.15) and Hispanic (10.27) neonates doubled when using dual codes compared to single, with White neonates having the highest across all factors, prevalence tripled for Black neonates (19.67). Prevalence was highest for Medicaid (35.93), rural locations (33.22), and the lowest income quartile (29.43), and these factors had the greatest increase in prevalence when using dual codes. Future research using this dual code approach may be beneficial to prevent missing NOWS cases, reducing the potential for underrepresenting U.S. NOWS prevalence and suboptimal management of affected infants.
