Knowledge and Training About Caring for Children With Intrauterine Opioid Exposure: A Multisite Pediatrician Survey

Describe primary care pediatrician knowledge and confidence in caring for children affected by intrauterine opioid exposure (IOE) and neonatal opioid withdrawal syndrome (NOWS), and identify priorities for additional training.

We conducted a cross-sectional survey at 7 US children's hospitals from April to June 2022. Eligible participants were pediatric attendings and pediatric residents practicing in primary care teaching clinics. Survey questions were adapted from prior studies of self-reported clinician knowledge and confidence and assessed clinician interest in additional training on various clinical topics related to IOE and NOWS. Frequencies were tabulated and chi-square comparisons were used to describe differences by demographics, practice setting, and patient population characteristics.

Of 1004 invited clinicians, 329 (32.8%) responses were returned, of whom 324 were included in the final analytic sample. Most respondents (n = 203, 62.7%) were residents, while 121 (37.4%) were attendings. One-third endorsed confidence that their training was sufficient to provide high-quality primary care to children affected by IOE and NOWS, with no significant difference between residents (32.5%) and attendings (34.0%). Both residents and attendings desire further training in anticipatory guidance topics, such as feeding and gastrointestinal symptoms, breastfeeding recommendations, monitoring after Hepatitis C exposure, and neurodevelopmental outcomes of children with IOE.

Most pediatricians feel that their training has been insufficient to provide high-quality primary care to infants affected by maternal opioid use. Additional training in graduate and continuing medical education aligned with pediatrician interest may enhance care for children with IOE and NOWS.