Infants Born With Neonatal Opioid Withdrawal Syndrome Have Greater Risk of Hospital Readmission

The 90-day hospital readmission rate for infants with neonatal opioid withdrawal syndrome (NOWS) is significantly greater relative to infants without NOWS, according to new research published in JAMA Network Open.

Relative to full-term newborns without abnormalities, infants born with NOWS are more likely to have health-related complications during the birth hospitalization. Researchers sought to evaluate all-cause and cause-specific readmissions among infants with NOWS compared with all other newborns.

In this retrospective, longitudinal study, the researchers gathered readmission data from the 90-day period following birth hospitalization discharge among infants with versus without NOWS. This readmissions information came from the Nationwide Readmissions Database (NRD), a database developed by the Agency for Healthcare Research and Quality for the Healthcare Cost and Utilization Project. Discharge records were obtained for calendar years 2016 through 2020. The discharge data was weighted to account for hospital location, ownership, teaching status, and number of beds. Specific ICD-10-CM codes were used to identify infants with NOWS and conditions leading to readmissions. Survey-weighted logistic regression was used to estimate unadjusted and adjusted odds ratios (AORs) for readmissions overall and according to cause.

A total of 13,855,246 newborns were identified in the NRD database, with 89,018 (0.6%) diagnosed with NOWS. Infants with NOWS had a 90-day all-cause readmission rate of 4.2% compared with 3.0% for infants without NOWS (P<.001). Of the infants with NOWS, 81.1% were born full-term and 53.8% were male.

After risk adjustment, infants with NOWS had higher odds of being readmitted for any cause relative to infants without NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Compared with infants without NOWS, infants with NOWS had higher odds for readmission for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), any head injury (AOR, 3.43; 95% CI, 2.37-4.94), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), skull fracture (AOR, 3.72; 95% CI, 2.33-5.93), anoxic brain injury or asphyxia (AOR, 3.28; 95% CI, 1.49-7.25) and falls (AOR, 5.30; 95% CI, 3.33-8.41). Further, infants with NOWS had higher odds of being diagnosed with maltreatment (AOR, 4.26; 95% CI, 2.19-8.27) or neglect (AOR, 14.18; 95% CI, 5.55-36.22) upon readmission.

Finally, the researchers found no significant difference in mortality odds between the 2 groups, a fact that persisted even after risk adjustment.

The study authors noted, “These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.”

The primary limitations of the study include the lack of data from some states that do not report on patients aged younger than 1 year to the NRD and reliance on ICD-10-CM codes and administrative data. 

This article originally appeared on Psychiatry Advisor