Newborns With Opioid Withdrawal at Higher Risk of Hospital Readmission

Infants with neonatal opioid withdrawal syndrome (NOWS) had a higher risk of hospital readmission than other newborns, a retrospective cohort study suggested.

Among nearly 14 million newborns, the 90-day, all-cause readmission rate was 4.2% for those with NOWS versus 3% for those without NOWS (P<0.001). After risk adjustment, infants with NOWS had higher odds of being readmitted within 90 days for any cause (adjusted odds ratio [AOR] 1.18, 95% CI 1.08-1.29), according to Julie Gaither, PhD, MPH, RN, of Yale School of Medicine in New Haven, Connecticut, and colleagues.

Infants with NOWS had significantly higher odds of readmissions for seizures (AOR 1.58, 95% CI 1.01-2.46), failure to thrive (AOR 1.99, 95% CI 1.36-2.93), traumatic brain injury (AOR 2.95, 95% CI 1.76-4.93), and skull fractures (AOR 3.72, 95% CI 2.33-5.93), they reported in JAMA Network Open.

“These findings reflect the complex psychosocial factors that may not only lead to opioid use disorder but also complicate parenting of infants with NOWS in their initial months at home, highlighting a need for improved funding and support for postdischarge medical and welfare services,” the researchers wrote. “Family-based, in-home services that focus concurrently on substance use treatment and parenting support may be particularly beneficial.”

Over the last two decades, increased use of both prescribed and illicit opioids among women of childbearing age in the U.S. has resulted in a five-fold increase in NOWS, Gaither and colleagues explained. Compared with full-term newborns without complications, infants with NOWS are more likely to experience central nervous system irritability, respiratory distress, intolerance to feedings, and several other adverse events in the hospital immediately after birth during withdrawal. This has resulted in a median length of stay of 12 days compared with less than 2 days for all other hospital births, they said.

“Far less is known about hospitalizations for infants with NOWS beyond the immediate postpartum period, particularly on a national level,” they wrote. “The few studies that have been published relied on data from selected states and hospitals and have suggested that infants with NOWS remain medically complex and vulnerable following the initial hospital discharge and have substantially higher rates of all-cause readmissions than other newborns.”

However, the generalizability of prior studies is “limited by several factors, including data from more than a decade ago, differences in comparison groups, and known variations across states in the care of infants with NOWS,” they added.

In the current study, infants with NOWS had higher odds of receiving a diagnosis of suspected or confirmed maltreatment upon readmission (AOR 3.87, 95% CI 2.45-6.11) and readmission for confirmed maltreatment (AOR 4.26, 95% CI 2.19-8.27) than those without the condition.

While infants with NOWS had higher odds of readmissions for confirmed neglect (AOR 14.18, 95% CI 5.55-36.22), there was no statistical difference in readmissions for confirmed physical abuse, nor did mortality differ significantly between the groups.

Gaither and colleagues examined discharge records for calendar years 2016 through 2020 in the Nationwide Readmissions Database, developed by the Agency for Healthcare Research and Quality for the Healthcare Cost and Utilization Project. Among the 13,855,246 newborns included, 0.6% were diagnosed with NOWS. Most infants were born full-term and were male.

Limitations included that some states do not report on patients younger than 1 year of age, and that measurement of clinical conditions was based on ICD-10-CM codes, which are subject to potential miscoding and errors of omission. Also, the extent to which the research team was able to examine clinical and social profiles of children and families was limited, and researchers were unable to control for variation across states in the care of infants with NOWS and to track patients across years, they added.

“Finally, in choosing a control group to serve as a comparator for infants with NOWS, there was no clear choice that stood out as ideal,” they said. “We felt that the most straightforward method was to compare infants with NOWS with those without NOWS.”

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