Wide Variation Found in Care of Opioid-Exposed Newborns

Debra L. Bogen, Bonny L. Whalen, Laura Kair, Mark Vining, Beth A. King

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. We sought to identify practice variations for newborns with in utero chronic opioid exposure among hospitals in the Better Outcomes Through Research for Newborns (BORN) network. Methods Nursery site leaders completed a survey about hospitals’ policies and practices regarding care for infants with chronic opioid exposure (≥3 weeks). Results The 76 (80%) of 95 respondent hospitals were in 34 states, varied in size (<500 to >8000 births and <10 to >200 opioid-exposed infants per year), with most affiliated with academic centers (89%). Most (80%) had protocols for newborn drug exposure screening; 90% used risk-based approaches. Specimens included urine (85%), meconium (76%), and umbilical cords (10%). Of sites (88%) with NAS management protocols, 77% addressed medical management, 72% nursing care, 72% pharmacologic treatment, and 58% supportive care. Morphine was the most common first-line pharmacotherapy followed by methadone. Observation periods for opioid-exposed newborns varied; 57% observed short-acting opioid exposure for 2 to 3 days, while 30% observed for ≥5 days. For long-acting opioids, 71% observed for 4 to 5 days, 19% for 2 to 3 days, and 8% for ≥7 days. Observation for NAS occurred mostly in level 1 nurseries (86%); however, most (87%) transferred to NICUs when pharmacologic treatment was indicated. Conclusions Most BORN hospitals had protocols for the care of opioid-exposed infants, but policies varied widely and characterized areas of needed research. Identification of variation is the first step toward establishing best practice standards to improve care for this rapidly growing population.

Original languageEnglish (US)
Pages (from-to)374-380
Number of pages7
JournalAcademic Pediatrics
Volume17
Issue number4
DOIs
StatePublished - May 1 2017

Fingerprint

Opioid Analgesics
Newborn Infant
Nurseries
Observation
Outcome Assessment (Health Care)
Infant Care
Meconium
Preclinical Drug Evaluations
Umbilical Cord
Practice Management
Methadone
Nursing Care
Practice Guidelines
Morphine
Length of Stay
Urine
Parturition
Drug Therapy
Therapeutics
Research

Keywords

  • neonatal abstinence syndrome (NAS)
  • newborn nursery
  • NICU
  • opioid
  • variation in care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Wide Variation Found in Care of Opioid-Exposed Newborns. / Bogen, Debra L.; Whalen, Bonny L.; Kair, Laura; Vining, Mark; King, Beth A.

In: Academic Pediatrics, Vol. 17, No. 4, 01.05.2017, p. 374-380.

Research output: Contribution to journalArticle

Bogen, DL, Whalen, BL, Kair, L, Vining, M & King, BA 2017, 'Wide Variation Found in Care of Opioid-Exposed Newborns', Academic Pediatrics, vol. 17, no. 4, pp. 374-380. https://doi.org/10.1016/j.acap.2016.10.003
Bogen, Debra L. ; Whalen, Bonny L. ; Kair, Laura ; Vining, Mark ; King, Beth A. / Wide Variation Found in Care of Opioid-Exposed Newborns. In: Academic Pediatrics. 2017 ; Vol. 17, No. 4. pp. 374-380.
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