Implicit Racial Bias in Evaluation of Neonatal Opioid Withdrawal Syndrome

Area of Science:

• Neonatal Medicine
• Healthcare Disparities
• Medical Education and Bias

Background:

• Neonatal opioid withdrawal syndrome (NOWS) requires accurate assessment for effective treatment.
• Racial disparities exist in healthcare, potentially influenced by implicit biases.
• The Modified Finnegan Score (MFS) is used to quantify neonatal opioid withdrawal severity.

Purpose of the Study:

• To assess implicit bias in nurses using the MFS for neonatal opioid withdrawal.
• To evaluate if race influences the assessment of opioid treatment needs in Black versus White infants.

Main Methods:

• Nurses were presented with clinical vignettes of infants experiencing opioid withdrawal.
• Participants were randomized to view vignettes with photos of either Black or White infants.
• Modified Finnegan Score (MFS) results were compared based on the infant's perceived race.

Main Results:

• Nurses aged 35 years or younger scored Black infants lower than White infants on vignette 2 (MFS 8.3 vs. 9.5, p=0.012).
• Nurses with less than 5 years of experience also scored Black infants lower (MFS 8.2 vs. 9.6, p=0.032).
• Nurses with 10 years or less of experience showed similar bias (MFS 8.3 vs. 9.5, p=0.0083).

Conclusions:

• Implicit bias among nurses may contribute to differential assessment of neonatal opioid withdrawal.
• Findings suggest that racial bias could play a role in disparities in opioid treatment for infants.