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

Author:

Young Leslie W.1,Hu Zhuopei2,Annett Robert D.3,Das Abhik4,Fuller Janell F.5,Higgins Rosemary D.67,Lester Barry M.8,Merhar Stephanie L.910,Simon Alan E.11,Ounpraseuth Songthip2,Smith P. Brian12,Crawford Margaret M.4,Atz Andrew M.13,Cottrell Lesley E.14,Czynski Adam J.15,Newman Sarah16,Paul David A.17,Sánchez Pablo J.18,Semmens Erin O.19,Smith M. Cody14,Turley Christine B.20,Whalen Bonny L.21,Poindexter Brenda B.22,Snowden Jessica N.23,Devlin Lori A.24,

Affiliation:

1. Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, Vermont;

2. Departments of Biostatistics and

3. Department of Pediatrics, Medical Center, University of Mississippi, Jackson, Mississippi;

4. Research Triangle Institute International, Rockville, Maryland;

5. Health Sciences Center, The University of New Mexico, Albuquerque, New Mexico;

6. National Institute of Child Health and Human Development, Bethesda, Maryland;

7. College of Health and Human Services, George Mason University, Fairfax, Virginia;

8. Department of Pediatrics and Center for the Study of Children at Risk, Warren Alpert Medical School, Brown University and

9. Division of Neonatology and Perinatal Institute and

10. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;

11. Environmental Influences on Child Health Outcomes Program and Office of the Director, National Institutes of Health, Rockville, Maryland;

12. Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina;

13. Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina;

14. Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia;

15. Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island;

16. Nebraska Medical Center, Omaha, Nebraska;

17. Division of Neonatology, Department of Pediatrics, ChristianaCare, Newark, Delaware;

18. Nationwide Children’s Hospital and College of Medicine, The Ohio State University, Columbus, Ohio;

19. School of Public and Community Health Sciences, University of Montana, Missoula, Montana;

20. Department of Pediatrics, School of Medicine, University of South Carolina, Columbia, South Carolina;

21. Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and

22. Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

23. Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas;

24. Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

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