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Updated: Aug 26, 2025

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Addressing drivers of healthcare utilization for neonatal opioid withdrawal syndrome

Megan Glait1, Andrea Moyer2, Kris Saudek3

  • 1University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|October 6, 2022
PubMed

Insights

Implementing quality improvement initiatives significantly reduced healthcare utilization for infants at risk of neonatal opioid withdrawal syndrome (NOWS). This study demonstrates a successful strategy for managing NOWS infants and lowering costs.

Area of Science:

  • Neonatal care
  • Quality Improvement Science
  • Healthcare Management

Background:

  • Infants at risk of neonatal opioid withdrawal syndrome (NOWS) often experience high healthcare utilization.
  • Effective strategies are needed to reduce healthcare utilization and associated costs for this vulnerable population.

Purpose of the Study:

  • To decrease healthcare utilization for infants at risk of NOWS by 30% within one year and sustain this reduction for two years.
  • To identify and address key drivers of variability in healthcare utilization for NOWS infants.

Main Methods:

  • Utilized Plan-Do-Study-Act (PDSA) cycles informed by baseline data from three newborn nurseries (January 2016 - June 2018).
  • Employed Shewhart process control charts to monitor length of stay (LOS), pharmacologic treatment (PT) rates, and direct costs (DC).
  • Evaluated process and balancing measures for special cause variation (SCV) from August 2018 to December 2021.

Main Results:

  • Achieved a significant downward special cause variation (SCV) in LOS, reducing it from 12.6 to 4.4 days.
  • Demonstrated a substantial decrease in pharmacologic treatment (PT) rates from 53% to 17%.
  • Reduced direct costs (DC) from $12,593.82 to $5,219.17 per infant.

Conclusions:

  • Transitioning from the MFNASS to ESC model led to a marked decrease in healthcare utilization for infants at risk of NOWS.
  • Quality improvement (QI) methodology successfully identified persistent variability drivers, including the COVID-19 pandemic and provider specialty.
  • The findings underscore the effectiveness of QI in optimizing care for NOWS infants and reducing healthcare resource burden.
Abstract

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