title: Wide Variation Found in Care of Opioid-Exposed Newborns.
abstract: 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.
  
  
  
  Nursery site leaders completed a survey about hospitals' policies and practices regarding care for infants with chronic opioid exposure (≥3 weeks).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa. Electronic address: bogendl@upmc.edu.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Bonny L
authors.initials: BL
authors.lastname: Whalen
authors.affiliation: Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Pediatrics, University of California Davis Medical Center, Sacramento, Calif.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Kair
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, University of Massachusetts Medical School, Worchester, Mass.
authors.forename: Mark
authors.initials: M
authors.lastname: Vining
authors.affiliation: Academic Pediatric Association, McLean, Va.
authors.forename: Beth A
authors.initials: BA
authors.lastname: King
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008403:Mass Screening; D008470:Meconium / Q000737:chemistry; D008691:Methadone / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D009725:Nurseries, Hospital; D009293:Opioid-Related Disorders; D016134:Organizational Policy; D010360:Patient Transfer; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications; D014556:Urine / Q000737:chemistry
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008691:Methadone
keywords: NICU; neonatal abstinence syndrome (NAS); newborn nursery; opioid; variation in care