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Predictors of pharmacologic therapy for neonatal opioid withdrawal syndrome: a retrospective analysis of a statewide database

Journal of Perinatology volume 41, pages 1381–1388 (2021)Cite this article

Subjects

Abstract

Objective

Identify factors associated with the need for pharmacologic therapy (PT) among opioid exposed newborn (OENs).

Study design

Retrospective analysis of a statewide database of OENs from 2017 through 2019. Multivariable mixed-effects logistic regression modeled the association of maternal characteristics, infant characteristics, and family engagement practices on the receipt of PT.

Results

Of 2098 OENs, 44.8% required PT for NOWS. Higher odds of PT were associated with in-utero exposure to medication treatment for opioid use disorder (MOUD) and non-prescribed opioids in addition to MOUD; nicotine, benzodiazepines, SSRIs; male; out-born infants and mother’s ineligibility to provide breast-milk. Lower odds were associated with increasing birth year, skin-to-skin (STS) care, and rooming-in.

Conclusion

Male, out-born infants exposed to MOUD with additional non-prescribed opioids, nicotine, benzodiazepines and SSSRIs with mothers ineligible to provide breast-milk were more likely to require PT, while modifiable care practices including STS care, and rooming-in decreased the likelihood of PT.

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Fig. 1: Receiver Operating Characteristics (ROC) Curve for the Multivariable mixed effects logistic regression model for factors associated with Pharmacologic Therapy.
Fig. 2: Standardized Pharmacologic Therapy Ratio (Observed /Expected) by Hospital.

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Acknowledgements

The authors gratefully acknowledge the contributions of their subjects, and their subjects’ families, as well as those of their colleagues.

Funding

This work has been supported by programmatic funding from Health Policy Commission of Massachusetts.

PNQIN Perinatal Opioid Project Collaborating Hospitals’:

Baystate Medical Center, Springfield, MA, USA; Baystate Franklin Medical Center, Greenfield, MA, USA; Berkshire Medical Center, Pittsfield, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Beverly Hospital, Beverly, MA, USA; Boston Medical Center, Boston, MA, USA; Brockton Hospital, Brockton, MA, USA; Cape Cod Hospital, Hyannis, MA, USA; Cooley-Dickenson Hospital, Northampton, MA, USA; Lowell General Hospital, Lowell, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Melrose-Wakefield Hospital, Melrose MA, USA; Mercy Medical Center, Springfield, MA, USA; Southcoast Health, Wareham, MA, USA; South Shore Hospital, South Weymouth, MA, USA; Tufts Medical Center, Boston, MA, USA; UMass Memorial Medical Center, Worcester, MA, USA.

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Authors and Affiliations

  1. Tufts Children’s Hospital, Boston, MA, USA

    Rachana Singh

  2. Beth Israel Deaconness Medical Center, Boston, MA, USA

    Mary Houghton & Munish Gupta

  3. Children’s Hospital Boston, Boston, MA, USA

    Patrice Melvin

  4. Boston Medical Center, Boston, MA, USA

    Elisha M. Wachman & Ronald Iverson Jr.

  5. Massachusetts Department of Public Health, Boston, MA, USA

    Hafsatou Diop

  6. Maine Medical Centre, Portland, ME, USA

    Alan Picarillo

  7. UMass Memorial Medical Center, Worcester, MA, USA

    Lawrence Rhein

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Correspondence to Rachana Singh.

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Singh, R., Houghton, M., Melvin, P. et al. Predictors of pharmacologic therapy for neonatal opioid withdrawal syndrome: a retrospective analysis of a statewide database. J Perinatol 41, 1381–1388 (2021). https://doi.org/10.1038/s41372-021-00969-z

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