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.
| Original language | English |
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| Article number | e2020008839 |
| Journal | Pediatrics |
| Volume | 147 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2021 |
Funding
FUNDING: All phases of this study were supported by the following grants: U10 HD27904, U10 HD36790, U10 HD53089, U24OD024957, UG1 HD21364, UG1 HD27853, UG1 HD68278, UG1OD024942, UG1OD024943, UG1OD024944, UG1OD024945, UG1OD024946, UG1OD024947, UG1OD024948, UG1OD024949, UG1OD024950, UG1OD024951, UG1OD024952, UG1OD024953, UG1OD024954, UG1OD024955, UG1OD024956, UG1OD024958, UG1OD024959, UL1 TR41, 1U2COD023375-01. This article is the product of work from the National Institute of Child Health and Human Development Neonatal Research Network and the Environmental influences on Child Health Outcomes Institutional Development Award States Pediatric Clinical Trials Network. Both networks are cooperative agreements with the National Institutes of Health. Only National Institutes of Health staff listed as authors have contributed to this article. Funded by the National Institutes of Health (NIH). The National Institutes of Health, the NICHD, and the National Center for Advancing Translational Sciences provided support for the NRN, and the ECHO Program (of the National Institutes of Health Office of the Director) provided support for the ISPCTN. Although the NICHD and NIH ECHO staff had input into the study design, conduct, analysis, and article drafting, the comments and views of the authors do not necessarily represent the views of NICHD or the ECHO Program, the National Institutes of Health, the Department of Health and Human Services, or the US government. All phases of this study were supported by the following grants: U10 HD27904, U10 HD36790, U10 HD53089, U24OD024957, UG1 HD21364, UG1 HD27853, UG1 HD68278, UG1OD024942, UG1OD024943, UG1OD024944, UG1OD024945, UG1OD024946, UG1OD024947, UG1OD024948, UG1OD024949, UG1OD024950, UG1OD024951, UG1OD024952, UG1OD024953, UG1OD024954, UG1OD024955, UG1OD024956, UG1OD024958, UG1OD024959, UL1 TR41, 1U2COD023375-01. This article is the product of work from the National Institute of Child Health and Human Development Neonatal Research Network and the Environmental influences on Child Health Outcomes Institutional Development Award States Pediatric Clinical Trials Network. Both networks are cooperative agreements with the National Institutes of Health. Only National Institutes of Health staff listed as authors have contributed to this article. Funded by the National Institutes of Health (NIH).
| Funder number |
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| UG1OD024956 |