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Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome
Julie R Gaither1,2, Matthew J Drago3, Matthew R Grossman1
1Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
Insights
Infants with neonatal opioid withdrawal syndrome (NOWS) face higher hospital readmission rates for various causes, including trauma and maltreatment. This highlights the need for integrated family support services addressing both substance use and parenting challenges.
Area of Science:
- Neonatal Health
- Public Health
- Pediatrics
Background:
- Neonatal opioid withdrawal syndrome (NOWS) cases have risen significantly.
- There is a lack of research on national hospital readmission rates for infants with NOWS.
Purpose of the Study:
- To investigate and compare 90-day hospital readmission rates for infants with and without NOWS.
- To identify specific causes of readmission for infants diagnosed with NOWS.
Main Methods:
- Retrospective cohort study using Nationwide Readmissions Database (2016-2020).
- Identified infants with NOWS using ICD-10-CM codes.
- Used survey-weighted logistic regression to analyze readmission rates, adjusting for covariates.
Main Results:
- Infants with NOWS had a higher 90-day all-cause readmission rate (4.2%) compared to those without (3.0%).
- NOWS was associated with increased odds of readmission for seizures, failure to thrive, traumatic brain injury, and skull fractures.
- Infants with NOWS showed higher odds of readmission for confirmed maltreatment, including neglect and physical abuse.
Conclusions:
- Infants with NOWS are at increased risk for hospital readmission due to various causes, including trauma and maltreatment.
- Findings suggest a need for family-centered, in-home services supporting substance use treatment and parenting for mothers with opioid use disorder.
Importance:
Although cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants.
Objective:
To examine hospital readmissions for infants with and without NOWS.
Design, Setting, And Participants:
This retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024.
Exposure:
Neonatal opioid withdrawal syndrome.
Main Outcome And Measures:
Survey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth.
Results:
Of the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (>36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS (P < .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant.
Conclusions And Relevance:
In this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.
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