Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Brief Communication
  • Published:

The association between intrauterine exposure to opioids, tobacco, alcohol, and cannabis and length of birth hospitalization among neonates without NOWS

Journal of Perinatology volume 43, pages 949–951 (2023)Cite this article

Subjects

Birth hospitalization length of stay (LOS) is extended for infants with neonatal opioid withdrawal syndrome (NOWS) [1], raising health care costs and complicating efforts to promote maternal-infant bonding [1, 2]. However, many infants exposed to opioids do not develop NOWS. The overall costs of intrauterine opioid exposure may be significantly greater if infants who do not develop withdrawal symptoms also have an increased LOS due to observation for the emergence of NOWS or other medical or social complications. Using data from the Environmental influences on Child Health Outcomes (ECHO)-wide cohort study funded by the National Institutes of Health, we evaluated whether opioid exposure not resulting in NOWS was associated with a longer LOS. We also performed similar evaluations of tobacco, alcohol, and cannabis, and considered the effect of combined exposures.

The current analysis used previously collected data to evaluate the association between intrauterine substance exposure and postnatal hospital LOS among neonates without NOWS. The analytic sample included infants from eight cohorts with complete data on intrauterine substance exposure and postnatal hospital LOS. Cohorts exclusively enrolling very low birthweight or preterm infants were excluded. Infants diagnosed with and/or receiving treatment for NOWS (parent report of opioid or drug withdrawal in the infant, or one or more NOWS screening tools administered, with either a positive score on that measure or pharmacological treatment for NOWS administered); 14 of the 5989 participants) were removed from analyses.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Data availability

The datasets for this paper are not publicly available because, per the NIH-approved ECHO Data Sharing Policy, ECHO-wide data have not yet been made available to the public for review/analysis. Requests to access the datasets should be directed to the ECHO Data Analysis Center, ECHO-DAC@rti.org.

References

  1. Strahan AE, Guy GP, Bohm M, Frey M, Ko JY. Neonatal Abstinence Syndrome incidence and health care costs in the United States, 2016. JAMA Pediatr. 2020;174:200–2. https://doi.org/10.1001/jamapediatrics.2019.4791

    Article  PubMed  Google Scholar 

  2. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. J Am Med Assoc. 2012;307:1934–40. https://doi.org/10.1001/jama.2012.3951

    Article  CAS  Google Scholar 

  3. R Core Development Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. http://www.r-project.org. Published 2020.

  4. Buuren S, Groothuis-Oudshoorn K. MICE: Multivariate Imputation by Chained Equations in R. J Stat Softw. 2011;45:1–67. https://doi.org/10.18637/JSS.V045.I03. van

    Article  Google Scholar 

  5. Bada HS, Das A, Bauer CR, Shankaran S, Lester B, LaGasse L, et al. Impact of prenatal cocaine exposure on child behavior problems through school age. Pediatrics. 2007;119:e348–e359.

    Article  PubMed  Google Scholar 

  6. Patrick SW, Barfield WD, Poindexter BB. Committee on Fetus and Newborn, Committee on Substance Use and Prevention. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020;146:e2020029074.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank our ECHO colleagues, the medical, nursing and program staff, as well as the children and families participating in the ECHO cohorts. We also acknowledge the contribution of the following ECHO program collaborators: ECHO Components—Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: Smith PB, Newby KL; ECHO Awardees and Cohorts—Massachusetts General Hospital, Boston, MA: Camargo C; Emory University, Atlanta, GA: Dunlop A; University of South Dakota, Vermillion, SD: Elliot A; Kaiser Foundation Research Institute, Oakland, CA: Ferrara A; University of California, Davis, Sacramento CA: Hertz-Picciotto I; University of Rochester Medical Center, Rochester, NY: O’Connor T; Magee-Women’s Research Institute & Foundation, Pittsburgh, PA: Simhan H; University of Utah, Salt Lake City, UT: Stanford J.

Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), UH3OD023253 (PI Camargo), UH3OD023318 (PI Dunlop), and UH3OD023279 (PI Elliot). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. C.S. Mott Department of Public Health and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI, USA

    Steven J. Ondersma

  2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Amii M. Kress, Ximin Li & Monica McGrath

  3. Department of Pediatrics and Department of Occupational Medicine, Epidemiology & Prevention, Zucker School of Medicine at Hofstra / Northwell and Cohen Children’s Medical Center, New Hyde Park, NY, USA

    Annemarie Stroustrup

  4. Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Robert D. Annett

  5. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Lyndsay A. Avalos & Monique M. Hedderson

  6. Avera Research Institute and Department of Pediatrics at the University of South Dakota Medical School, Sioux Falls, SD, USA

    Maria Talavera-Barber & Amy J. Elliott

  7. Department of Psychology, Emory University, Atlanta, GA, USA

    Patricia A. Brennan

  8. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA

    Carlos A. Camargo Jr

  9. Department of Psychiatry, Duke University and Adjunct Associate Professor, Department of Pediatrics, Duke University, Durham, NC, USA

    Elisabeth Conradt

  10. Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA

    Anne L. Dunlop

  11. Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Ruby H. N. Nguyen

  12. Analytics Program, Research Triangle Institute, Atlanta, GA, USA

    Grier P. Page

  13. University of Washington, Department of Pediatrics, Seattle Children’s Research Institute, Seattle, WA, USA

    Sheela Sathyanarayana

  14. Departments of Psychiatry and Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA

    Barry Lester

Authors
  1. Steven J. Ondersma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amii M. Kress
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annemarie Stroustrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert D. Annett
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lyndsay A. Avalos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Talavera-Barber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Patricia A. Brennan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos A. Camargo Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Elisabeth Conradt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anne L. Dunlop
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Amy J. Elliott
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Monique M. Hedderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ximin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Monica McGrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ruby H. N. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Grier P. Page
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Sheela Sathyanarayana
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Barry Lester
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AS, AK, MM, RA, RN, SO, CC, and AD made substantial contributions to the concept and design; the acquisition, analysis, or interpretation of the data; and writing and revising the paper. GP and LC made substantial contributions to the concept and design; the interpretation of the data; and revising the paper. AE, LA, MH, PB, and MB made substantial contributions to the interpretation of the data and revising the paper. SS and XL made substantial contributions to the acquisition, analysis, and interpretation of the data and revising the paper. All authors have approved the final version of the paper and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Steven J. Ondersma.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All original data collection as well as the present analyses were performed in accordance with the Declaration of Helsinki. The study protocol was approved by the local [or single ECHO] institutional review board. Written informed consent or parent’s/guardian’s permission was obtained along with child assent as appropriate, for ECHO-wide Cohort Data Collection Protocol participation and for participation in specific cohorts.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ondersma, S.J., Kress, A.M., Stroustrup, A. et al. The association between intrauterine exposure to opioids, tobacco, alcohol, and cannabis and length of birth hospitalization among neonates without NOWS. J Perinatol 43, 949–951 (2023). https://doi.org/10.1038/s41372-023-01694-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-023-01694-5

Search

Advanced search

Quick links