Wide Variation Found in Care of Opioid-Exposed Newborns

UMMS Affiliation

Department of Pediatrics

Publication Date


Document Type



Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Pediatrics | Substance Abuse and Addiction


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 (8000 births and 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.

DOI of Published Version



Acad Pediatr. 2017 May - Jun;17(4):374-380. doi: 10.1016/j.acap.2016.10.003. Epub 2016 Nov 23. Link to article on publisher's site

Journal/Book/Conference Title

Academic pediatrics

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