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

Leslie W Young1, Zhuopei Hu2, Robert D Annett3

  • 1Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, Vermont; leslie.young@uvm.edu.

Pediatrics
|January 2, 2021
PubMed

Insights

Significant variation exists in how hospitals care for infants with neonatal opioid withdrawal syndrome (NOWS). This wide range in treatment and outcomes suggests care may not be consistently effective or efficient for all infants with NOWS.

Area of Science:

  • Pediatric Healthcare
  • Neonatal Care
  • Clinical Variation

Background:

  • Pediatric medical care variations are common and impact patient outcomes.
  • Site-to-site variations in characteristics and care for infants with neonatal opioid withdrawal syndrome (NOWS) have not been quantified.
  • Understanding this variation is crucial for improving care standards.

Purpose of the Study:

  • To describe site-to-site variation in maternal-infant characteristics for infants with NOWS.
  • To quantify variation in infant management strategies for NOWS.
  • To assess differences in outcomes for infants with NOWS across different healthcare sites.

Main Methods:

  • A cross-sectional study analyzed 1377 infants (≥36 weeks' gestation) with NOWS.
  • Data were collected from 30 participating hospitals nationwide between July 2016 and June 2017.
  • Site-to-site variation was measured using site-level means, medians, or proportions for key parameters.

Main Results:

  • Wide variation observed in prenatal care adequacy (31.3%-100%) and maternal treatment (MAT: 5.9%-100%).
  • Significant differences in infant management, including toxicology screening (50%-100%) and pharmacologic therapy (6.7%-100%).
  • Variations noted in nonpharmacologic interventions, length of stay (2-28.8 days), and discharge rates (33.3%-91.1%).

Conclusions:

  • Considerable site-to-site variation exists across maternal characteristics, infant management, and outcomes for NOWS.
  • The observed magnitude of variation suggests care may not be consistently efficient or effective.
  • This variation necessitates consideration in future clinical trials, practice implementation, and policy development for NOWS care.
Abstract

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