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Neonatal withdrawal syndrome: reaching epidemic proportions across the globe
  1. Karel Allegaert1,2,
  2. John N van den Anker3,4,5,6
  1. 1Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
  2. 2Department of Development and Regeneration, KU Leuven, Leuven, Belgium
  3. 3Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington DC, USA
  4. 4Departments of Pediatrics, Integrative Systems Biology, Pharmacology and Physiology, George Washington University School of Medicine and Health Sciences, Washington DC, USA
  5. 5Intensive Care and Department of Pediatric Surgery, Erasmus MC—Sophia Children's Hospital, Rotterdam, The Netherlands
  6. 6Department of Paediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Karel Allegaert, Neonatal Intensive Care Unit, University Hospital, Herestraat 49, Leuven 3000, Belgium; karel.allegaert{at}uzleuven.be

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Davies et al1 have quantified the prevalence of neonatal withdrawal syndrome (NWS) and its trend in England between 1997 and 2011, and have compared these findings with similar cohort studies in the USA, Western Australia and Canada. Using national hospital administrative data, the authors came to the conclusion that (a) there is variability in the NWS prevalence between the different hospital trusts in England with a prevalence above the 97th centile (3 SD) in 7% of the trusts and that (b) the recorded rate of NWS remained high, but stable with a prevalence rate of 2.7/1000 live births (1997–2011).

The extensive variability in prevalence between hospitals or trusts confirms the data from a comparable report that used the relative number of neonatal intensive care unit (NICU) admissions for NWS in a given NICU as an indicator (number of NWS/total number of NICU admissions). While the median number was 4%, a 20-fold variability, from less than 2% to more than 50% of admissions, was documented between units.2 Similarly, there is also variability in the prevalence and its trends between countries. As discussed by the authors, this prevalence remained stable in Western Australia, but increased in the USA and Canada in more recent years. To further illustrate both the prevalence and its trend in different regions, we have reproduced the data as published by Davies et al1 in combination with other data retrieved from the literature in figure 1.3 This exercise also illustrates that the stable prevalence …

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