Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal

Authors

Leslie W. Young, Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, Vermont
Zhuopei Hu, Departments of Biostatistics
Robert D. Annett, Department of Pediatrics, Medical Center, University of Mississippi, Jackson, Mississippi
Abhik Das, Research Triangle Institute International, Rockville, Maryland
Janell F. Fuller, Health Sciences Center, The University of New Mexico, Albuquerque, New Mexico
Rosemary D. Higgins, National Institute of Child Health and Human Development, Bethesda, Maryland; College of Health and Human Services, George Mason University, Fairfax, Virginia
Barry M. Lester, Department of Pediatrics and Center for the Study of Children at Risk, Warren Alpert Medical School, Brown University
Stephanie L. Merhar, Division of Neonatology and Perinatal Institute and; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
Alan E. Simon, Environmental Influences on Child Health Outcomes Program and Office of the Director, National Institutes of Health, Rockville, Maryland
Songthip Ounpraseuth, Departments of Biostatistics
P Brian Smith, Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
Margaret M. Crawford, Research Triangle Institute International, Rockville, Maryland
Andrew M. Atz, Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
Lesley E. Cottrell, Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
Adam J. Czynski, Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
Sarah Newman, Nebraska Medical Center, Omaha, Nebraska
David A. Paul, Division of Neonatology, Department of Pediatrics, ChristianaCare, Newark, Delaware
Pablo J. Sánchez, Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio
Erin O. Semmens, School of Public and Community Health Sciences, University of Montana, Missoula, Montana
M Cody Smith, Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
Christine B. Turley, Department of Pediatrics, School of Medicine, University of South Carolina, Columbia, South Carolina
Bonny L. Whalen, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Brenda B. Poindexter, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Jessica N. Snowden, Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Lori A. Devlin, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK AND THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM INSTITUTIONAL DEVELOPMENT AWARDS STATES PEDIATRIC CLINICAL TRIALS NETWORK

Document Type

Article

Publication Date

1-1-2021

Abstract

BACKGROUND AND OBJECTIVES: Variation in pediatric medical care is common and contributes to differences in patient outcomes. Site-to-site variation in the characteristics and care of infants with neonatal opioid withdrawal syndrome (NOWS) has yet to be quantified. Our objective was to describe site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS.

METHODS: Cross-sectional study of 1377 infants born between July 1, 2016, and June 30, 2017, who were ≥36 weeks' gestation, with NOWS (evidence of opioid exposure and NOWS scoring within the first 120 hours of life) born at or transferred to 1 of 30 participating hospitals nationwide. Site-to-site variation for each parameter within the 3 domains was measured as the range of individual site-level means, medians, or proportions.

RESULTS: Sites varied widely in the proportion of infants whose mothers received adequate prenatal care (31.3%-100%), medication-assisted treatment (5.9%-100%), and prenatal counseling (1.9%-75.5%). Sites varied in the proportion of infants with toxicology screening (50%-100%) and proportion of infants receiving pharmacologic therapy (6.7%-100%), secondary medications (1.1%-69.2%), and nonpharmacologic interventions including fortified feeds (2.9%-90%) and maternal breast milk (22.2%-83.3%). The mean length of stay varied across sites (2-28.8 days), as did the proportion of infants discharged with their parents (33.3%-91.1%).

CONCLUSIONS: Considerable site-to-site variation exists in all 3 domains. The magnitude of the observed variation makes it unlikely that all infants are receiving efficient and effective care for NOWS. This variation should be considered in future clinical trial development, practice implementation, and policy development.

Publisher

American Academy of Pediatrics

Publication Title

Pediatrics

ISSN

1098-4275

Volume

147

Issue

1

DOI

10.1542/peds.2020-008839

Recommended Citation

Young LW, Hu Z, Annett RD, Das A, Fuller JF, Higgins RD, Lester BM, Merhar SL, Simon AE, Ounpraseuth S, Smith PB, Crawford MM, Atz AM, Cottrell LE, Czynski AJ, Newman S, Paul DA, Sánchez PJ, Semmens EO, Smith MC, Turley CB, Whalen BL, Poindexter BB, Snowden JN, Devlin LA; EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK AND THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM INSTITUTIONAL DEVELOPMENT AWARDS STATES PEDIATRIC CLINICAL TRIALS NETWORK. Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal. Pediatrics. 2021 Jan;147(1):e2020008839. doi: 10.1542/peds.2020-008839. Epub 2020 Dec 21. PMID: 33386337; PMCID: PMC7780957.