Site-to-Site Variation, Lack of Optimal Care for Neonatal Opioid Withdrawal

By Lisa Rapaport

January 12, 2021

(Reuters Health) - There is wide site-to-site variation in access to prenatal care for opioid use disorder and to neonatal treatment for opioid withdrawal, according to a U.S. study that suggests many infants may be getting suboptimal care.

Researchers examined data on 1,377 infants born between July 1, 2016, and June 30, 2017, who had neonatal opioid withdrawal syndrome (NOWS) and received treatment at one of 30 hospitals nationwide. Hospitals in the study had from 4 to 161 NOWS cases (mean 45.9), and treated between 4 and 423 cases per 1,000 birth admissions (mean 31.8).

Hospitals varied widely in the proportion of infants receiving toxicology screening (50% to 100%), medication for withdrawal (6.7% to 100%), secondary medications (1.1% to 69.2%), fortified feeds (2.9% to 90%), and maternal breast milk (22.2% to 83.3%), according to the results published in Pediatrics.

"To the extent that we are able to do so, we should work to minimize this variation as we look to optimize the care that we provide to mothers with opioid use disorder (OUD) and their infants," said lead study author Dr. Leslie Young, an assistant professor of pediatrics at the Larner College of Medicine at the University of Vermont and a neonatologist at the University of Vermont Children's Hospital in Burlington.

Physicians and community partners can work toward this by advocating for increased availability and access to maternal care services, including medication-assisted treatment for pregnant women with OUD, and by looking to reduce barriers to this care, Dr. Young said by email. Clinicians can also help better provide for OUD by recognizing trauma-informed care as a critical component of the care provided to these women, Dr. Young added.

The study results show wide variation in prenatal care for women with OUD, demonstrating the need to improve access to treatment.

Overall, only 68.2% of mothers received adequate prenatal care, defined as at least three visits during pregnancy with care starting during the first trimester. Across hospitals, the proportion of women receiving adequate prenatal care ranged from 31.3% to 100% (mean 66.1%).

Even fewer women in the study received prenatal medication-assisted treatment for OUD (62.4%) or prenatal counseling about care infants would need for NOWS (18.4%). Across hospitals, the proportion of women receiving medication for OUD ranged from 5.9% to 100% (mean 54.2%) and the proportion of mothers receiving counseling about NOWS treatment ranged from 1.9% to 75.5% (mean 24.9%).

It's possible that some of the site-to-site variation might be warranted based on factors not measured in the study, the authors note. It's also possible that results from the 30 hospitals in the study might not be representative of all hospitals nationwide.

Even so, the variation in care seen in the study highlights a lack of standard practice for NOWS treatment and the need for more research to inform optimal treatment protocols, said Dr. Stephen Patrick, director of the Center for Child Health Policy at Vanderbilt University School of Medicine in Nashville, Tennessee.

"For example, we have no standard definition of neonatal opioid withdrawal syndrome and we are using tools to assess the syndrome that lack reliability and are subjective," Dr. Patrick, who wasn't involved in the study, said by email. "These basic issues mean that even comparing hospital-to-hospital outcomes is difficult."

SOURCE: Pediatrics, online December 21, 2020.