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.
American Academy of Pediatrics
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.