As the saying goes misery loves company and the following graph tells the story of NAS in North America very well.\u00a0\u00a0There has been a dramatic rise in admissions with a progressive increase in length of stay.\u00a0 Attempts to curtail use of these drugs in pregnancy by criminalizing the use of drugs for the unborn fetus has not gone well; Mandatory Drug-Testing in Pregnancy: Lesson Learned<\/a> The use of opioid analgesic use in pregnancy has risen to an extremely high level and in large part is contributory in the US to such high rates of admission. \u00a0The answer may also lie in a change to the approach of treatment that occurred in the middle of this epoch and is shown in the next figure indicating what type of medication was utilized for treatment.\u00a0In 2010 the Cochrane Database for Systematic Reviews published a comparison of the evidence supporting either opiates or phenobarbital for the primary treatment of NAS.<\/a><\/p>\n The conclusions of this paper changed the practice in our own and from the data presented here other centres as around 2009 – 2010, the use of phenobarbital decreased while morphine rose consistent with the recommendations from this group. \u00a0Morphine was selected as it appeared to reduce the incidence of seizures although I have to mention I have never seen a case myself, so I remain curious as to how common they really are. \u00a0In the review they also commented however that the use of opiates for treatment was associated with a prolongation of hospital stay. \u00a0The reasons for this are in part explained by practitioner reluctance to discharge an infant home on an opiate. \u00a0Doing so on low dose phenobarbital would have a much greater comfort level due to the common use for seizure control over the years in a home setting. \u00a0This may be reflected in the findings as well in this paper that the practice of discharging on medications for NAS control decreased during the period studied from 4% down to 1-2%. \u00a0Given the large number of babies being seen, this would represent a lot more infants in hospital and therefore a longer stay.<\/p>\n It is also tempting to blame the drugs that the mothers were exposed to but it would appear that there really is no basis for this based on this graph from the supplementary appendix\u00a0The percentage of infants exposed to methadone remained the same, so higher use can not be blamed (which has been associated with higher rates of NAS).<\/p>\n Compounding the problem of NAS is that there are competing demands in many areas of the country where higher birth rates demand more NICU beds which are quite often occupied with NAS babies. \u00a0There is clearly work that is needed in the field to turn the tide and reduce NAS admissions and certainly length of stay. \u00a0As for how to do this there are a few ideas.<\/p>\n![\"trend](\"\/wp-content\/uploads\/2015\/04\/trend-copy.png?w=209\")
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