Elsevier

The Journal of Pediatrics

Volume 245, June 2022, Pages 47-55
The Journal of Pediatrics

Original Article
Impact of Coronavirus Disease-2019 on Hospital Care for Neonatal Opioid Withdrawal Syndrome

https://doi.org/10.1016/j.jpeds.2022.02.001Get rights and content

Objective

To compare prenatal exposures, hospital care processes, and hospitalization outcomes for opioid-exposed newborns before and during the coronavirus disease 2019 (COVID-19) pandemic.

Study design

In this multicenter retrospective analysis, data were collected from 19 Massachusetts hospitals, including 5 academic and 14 community hospitals. The pre-COVID-19 cohort was defined as births occurring during March 1, 2019-February 28, 2020, and the COVID-19 cohort was defined as births occurring during March 1, 2020-December 31, 2020. Opioid-exposed newborns born at ≥35 weeks of gestation were included. Differences in prenatal substance exposures, hospital care processes, and neonatal opioid withdrawal syndrome (NOWS) outcomes, including pharmacologic treatment for NOWS (PharmTx), length of stay (LOS), and as-needed (prn) treatment failure rates, were evaluated.

Results

There were 663 opioid-exposed newborns in the pre-COVID-19 group and 476 in the COVID-19 group. No between-group differences were seen in prenatal substance exposures or the need for PharmTx. Compared with the pre-COVID-19 group, in the COVID-19 group there was less rooming-in after maternal discharge (53.8% vs 63.0%; P = .001) and less care in the pediatric unit setting (23.5% vs 25.3%; P = .001), longer LOS (adjusted risk ratio, 1.04; 95% CI, 1.01-1.08), and a higher rate of breast milk receipt at discharge (aOR, 2.03; 95% CI, 1.22-3.39). Within the subset of academic centers, more infants failed prn treatment in the COVID-19 group (53.8% vs 26.5%, P = .02; aOR, 3.77; 95% CI, 0.98-14.5).

Conclusions

Among the hospitals in our collaborative, hospital processes for NOWS, including care setting, rooming-in, and LOS were negatively impacted in the COVID-19 group, particularly in academic medical centers.

Keywords

neonatal abstinence syndrome
SARS-CoV-2

Abbreviations

COVID-19
Coronavirus disease 2019
ER
Emergency room
ESC
Eat, Sleep, Console
LOS
Length of stay
NICU
Neonatal intensive care unit
NOWS
Neonatal opioid withdrawal syndrome
OUD
Opioid use disorder
PharmTx
Pharmacologic treatment for neonatal opioid withdrawal syndrome
PNQIN
Perinatal-Neonatal Quality Improvement Network of Massachusetts
Prn
As necessary

Cited by (0)

Supported in part by the Massachusetts Department of Public Health (Centers for Disease Control Grant NU58DP006371, to H.D.). The authors declare no conflicts of interest.

Portions of this data were previously presented as an abstract during the 2021 Pediatric Academic Society annual meeting, April 30 - May 4, 2021 (Virtual).

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