Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jan;147(1):e2020008839.
doi: 10.1542/peds.2020-008839. Epub 2020 Dec 21.

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

Leslie W Young  1 , Zhuopei Hu  2 , Robert D Annett  3 , Abhik Das  4 , Janell F Fuller  5 , Rosemary D Higgins  6   7 , Barry M Lester  8 , Stephanie L Merhar  9   10 , Alan E Simon  11 , Songthip Ounpraseuth  2 , P Brian Smith  12 , Margaret M Crawford  4 , Andrew M Atz  13 , Lesley E Cottrell  14 , Adam J Czynski  15 , Sarah Newman  16 , David A Paul  17 , Pablo J Sánchez  18 , Erin O Semmens  19 , M Cody Smith  20 , Christine B Turley  21 , Bonny L Whalen  22 , Brenda B Poindexter  23 , Jessica N Snowden  24 , Lori A Devlin  25 ; EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK AND THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM INSTITUTIONAL DEVELOPMENT AWARDS STATES PEDIATRIC CLINICAL TRIALS NETWORK
Affiliations
Observational Study

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

Leslie W Young et al. Pediatrics. 2021 Jan.

Abstract

Background and objectives: Variation in pediatric medical care is common and contributes to differences in patient outcomes. Site-to-site variation in the characteristics and care of infants with neonatal opioid withdrawal syndrome (NOWS) has yet to be quantified. Our objective was to describe site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS.

Methods: Cross-sectional study of 1377 infants born between July 1, 2016, and June 30, 2017, who were ≥36 weeks' gestation, with NOWS (evidence of opioid exposure and NOWS scoring within the first 120 hours of life) born at or transferred to 1 of 30 participating hospitals nationwide. Site-to-site variation for each parameter within the 3 domains was measured as the range of individual site-level means, medians, or proportions.

Results: Sites varied widely in the proportion of infants whose mothers received adequate prenatal care (31.3%-100%), medication-assisted treatment (5.9%-100%), and prenatal counseling (1.9%-75.5%). Sites varied in the proportion of infants with toxicology screening (50%-100%) and proportion of infants receiving pharmacologic therapy (6.7%-100%), secondary medications (1.1%-69.2%), and nonpharmacologic interventions including fortified feeds (2.9%-90%) and maternal breast milk (22.2%-83.3%). The mean length of stay varied across sites (2-28.8 days), as did the proportion of infants discharged with their parents (33.3%-91.1%).

Conclusions: Considerable site-to-site variation exists in all 3 domains. The magnitude of the observed variation makes it unlikely that all infants are receiving efficient and effective care for NOWS. This variation should be considered in future clinical trial development, practice implementation, and policy development.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Site-level variation in maternal and infant characteristics. The box plots consist of the 25th (quartile 1), 50th (median), and 75th (quartile 3) percentiles. The length of the whiskers represents the minimum (quartile 1 – 1.5 × IQR) and maximum (quartile 3 + 1.5 × IQR), where IQR = quartile 3 – quartile 1 (IQR). Each dot represents a single site proportion or mean, as appropriate, and the asterisk denotes outliers.
FIGURE 2
FIGURE 2
Site-level variation in infant management. The box plots consist of the 25th (quartile 1), 50th (median), and 75th (quartile 3) percentiles. The length of the whiskers represents the minimum (quartile 1 – 1.5 × IQR) and maximum (quartile 3 + 1.5 × IQR), where IQR = quartile 3 – quartile 1 (IQR). Each dot represents a single site proportion and the asterisk denotes outliers.
FIGURE 3
FIGURE 3
Site-level variation in the initiation and length of pharmacologic therapy. The box plots consist of the 25th (quartile 1), 50th (median), and 75th (quartile 3) percentiles. The length of the whiskers represents the minimum (quartile 1 – 1.5 × IQR) and maximum (quartile 3 + 1.5 × IQR), where IQR = quartile 3 – quartile 1 (IQR). Each dot represents a single site mean and the asterisk denotes outliers.
FIGURE 4
FIGURE 4
Site-level variation in infant LOS. The box plots consist of the 25th (quartile 1), 50th (median), and 75th (quartile 3) percentiles. The length of the whiskers represents the minimum (quartile 1 – 1.5 × IQR) and maximum (quartile 3 + 1.5 × IQR), where IQR = quartile 3 – quartile 1 (IQR). Each dot represents a single site mean and the asterisk denotes outliers.
See this image and copyright information in PMC

Comment in

References

    1. Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012 [published correction appears in J Perinatol. 2015;35(8):667]. J Perinatol. 2015;35(8):650–655 - PMC - PubMed
    1. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;307(18):1934–1940 - PubMed
    1. Clark ME, Cummings BM, Kuhlthau K, Frassica N, Noviski N. Impact of pediatric intensive care unit admission on family financial status and productivity: a pilot study. J Intensive Care Med. 2019;34(11–12):973–977 - PubMed
    1. Lyu H, Xu T, Brotman D, et al. Overtreatment in the United States. PLoS One. 2017;12(9):e0181970. - PMC - PubMed
    1. Tolia VN, Patrick SW, Bennett MM, et al. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. N Engl J Med. 2015;372(22):2118–2126 - PubMed

Publication types

MeSH terms

Substances