The incidence of neonatal abstinence syndrome (NAS) steadily and notably increased in Canada between the years 2005 to 2006 and 2015 to 2016, following similar trends seen in the United States, England, and Australia, according to findings published in Pediatrics. Researchers believe this increase sheds light on the importance of implementing integrated care for the mother-infant dyad during and after the birth process.

Data of singleton hospital live births obtained from the Canadian Institute for Health Information (CIHI) were retrospectively reviewed in this descriptive cross-sectional study. Only births between 2005 and 2006 to 2015 and 2016 were included in the analysis (n=2,881,789). Delivery hospitalization data analyzed included demographic characteristics, incidence of NAS, and neonatal/maternal morbidities. Primary composite outcomes included maternal and neonatal mortality and/or severe morbidity (eg, mortality and potentially life-threatening conditions in mother and infant, respectively).

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A total of 10,027 mother-infant dyads with NAS were included in the final analysis. From 2005 and 2006 to 2015 and 2016, there was a respective increase in the incidence of NAS from 0.20% to 0.51%. Infants with NAS were more likely to be born preterm at <37 weeks (20.42% vs 6.33%; P <.001) and to have a higher incidence of maternal mortality vs the comparison group (1.99 vs 0.31 per 10,000 women, respectively; adjusted odds ratio [aOR], 6.53; 95% CI, 1.59-26.74).

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Additionally, maternal mortality and/or severe morbidity was higher in the NAS group (3.10% vs 1.35%; aOR, 2.21; 95% CI, 1.97-2.49). Mortality rates for infants with NAS vs infants without NAS was 0.12% and 0.19%, respectively (aOR, 0.28; 95% CI, 0.15-0.53). Infants with NAS had higher neonatal mortality and/or severe morbidity compared with infants without NAS (6.36% vs 1.73%, respectively; aOR, 2.27; 95% CI, 2.06-2.50).

Limitations of this study included its retrospective design as well as the lack of data on illicit vs nonillicit opioid use in the mothers.

“Treatment of the mother-infant dyad should be the goal because optimal health care provision during this crucial period contributes to harm reduction and prevention of adverse sequelae,” the researchers concluded. In a final remark the researchers state that, “pregnancy and the postpartum period present a unique opportunity for compassionate multidisciplinary care to improve the health and well-being of these vulnerable mothers and their infants.”

Disclosure: None of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Lisonkova S, Richter LL, Ting J, et al. Neonatal abstinence syndrome and associated neonatal and maternal mortality and morbidity. Pediatrics. 2019;144(2).