Maternal Substance Use and Neonatal Intensive Care Unit (NICU) Admission Among Medicaid Beneficiaries: A State-wide Audit

Introduction: Mounting evidence suggested a strong association between maternal substance abuse and poor neonatal outcomes. This study aims to investigate an association between maternal substance abuse and NICU admissions and transitions in the LOC among newborns who were Medicaid beneficiaries. Methods: A hybrid linkage approach was utilized to link two datasets (Birth Registry and Nevada Medicaid Claims) spanning 2015-2021 with nearly 85% linkage efficiency. The infant records were analyzed using univariate and bivariate statistical methods with significance level set at 5%. Results: A total of 84,181 infant records were identified, of which 70,817 (84.1%) admitted to a single LOC during their entire course of hospitalization and remaining 13,364 (15.9%) had the multiple transitions in the LOC. A significantly larger proportion of infants with multiple transitions in the LOC had mothers with a history of consuming tobacco (9.1% vs. 5.9%), cigarettes (8.8% vs. 5.8%), drugs (33.8% vs. 19.9%, and prescription drugs (24.6% vs. 14.5%) as opposed to their well-born nursery care infants p<0.001). Of 70,817 infants admitted to the single LOC, nearly 4% were admitted to the higher NICU levels (0173 and 0174). Among these babies, infants admitted to the higher level of care (e.g. intermediate and NICU) were born to mothers with a history of substance abuse as opposed to those receiving the routine care. Conclusion: The positive association between maternal substance use and NICU admissions underscore the need of developing harm reduction strategies in perinatal settings to improve health outcomes of mother-infant dyads.