Care of Opioid-Exposed Newborns is Not Uniform Across Hospitals, Children’s Hospital Research Shows

Increasing prenatal opioid use has resulted in a rapidly growing population of opioid exposed newborns. However, there is a wide variation in the type of care that these newborns receive and more research is needed to establish best practices and standards of care, according to new research from Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine published online in the journal Academic Pediatrics.

The study analyzed care practices for newborns with Neonatal Abstinence Syndrome (NAS), a condition that results from opioid withdrawal and associated with significant health care costs related to prolonged newborn hospital stays.

“The opioid epidemic has not spared pregnant women and their children,” said Children’s Hospital pediatrician Debra Bogen, M.D., the lead author of the study and an associate professor of pediatrics at Pitt’s School of Medicine. “As a result, we have seen a significant increase in the numbers of newborns who require care in our nation’s nurseries.”

In many institutions, NAS care is provided in neonatal intensive care units (NICUs), an approach that is expensive and may not be necessary for infants who are not critically ill. Furthermore, the resulting separation of mother and child may be counterproductive to optimal care.

To assess comprehensive NAS care practices nationwide, including infant drug screening, pharmacologic treatment, rooming-in, infant feeding practices and discharge planning, Dr. Bogen and colleagues conducted an online survey in collaboration with members of the Better Outcomes through Research for Newborns (BORN) Network of the Academic Pediatric Association, a national collaborative of pediatric clinicians and researchers.

The team surveyed nursery site leaders from 76 hospitals in 34 states about hospital policies and practices regarding care for infants exposed to opioids for at least the last 3 weeks before delivery.

They found that 80 percent of the hospitals had protocols for newborn drug exposure screening and 90 percent used risk-based approaches. However, observation periods for opioid-exposed newborns varied widely and were inconsistent with national recommendations. For example, 44 percent of hospitals observed infants exposed to opioids that are active for a short duration in the body (short-acting opioids) for more than three days, the recommended time, while 47 percent of hospitals observed newborns exposed to long-acting opioids for fewer than five days, the recommended time. The wide variation combined with a lack of data to support current expert recommendations point to this as an important but poorly understood area, according to the study authors.

In addition, the team also found variation in how long mothers and infants were separated, feeding practices, and in what stage of treatment infants were discharged.

“Our survey confirms that although most nurseries have implemented standardized protocols, wide variation in the actual policies exist in regards to supportive care approaches, feeding methods and duration of observation for NAS,” noted Dr. Bogen. “Additionally, most newborns administered drugs for NAS are cared for in NICUs and separated from their mothers at a time when they will benefit most from maternal contact. The high level of variation in care suggests the need to identify optimal care strategies for this rapidly growing population of infants.”

The study was supported by National Institutes of Health grant UL1TR001857.

Other authors include Bonny Whalen, M.D., Dartmouth-Hitchcock Medical Center; Laura Kair, M.D., University of Iowa; Mark Vinning, M.D., University of Massachusetts Medical School; and Beth King, Academic Pediatric Association.