Hugs Not Drugs – 

Jan. 1, 2021 – As complications of the opioid crisis spread in US communities, nurseries across the country also felt the impact of the crisis. Over the last 2 decades, the number of infants diagnosed with neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome, grew nearly eightfold, reaching 1 infant diagnosed every 15 minutes in the United States in 2016. However, just as overdose deaths represent only a fraction of adults affected by the opioid crisis, diagnoses of NOWS represent a fraction of all opioid-exposed infants. Currently, there are no gold standard diagnostic criteria for NOWS nor validated quality measures for opioid-exposed infants. Thus, there remain substantial gaps in care delivered.

In this issue of Pediatrics, Young et al4 present findings from a large cohort of infants treated at 30 hospitals participating in the ACT NOW (Advancing Clinical Trials in Neonatal Opioid Withdrawal Current Experience Study). The authors found profound variation in care for NOWS in every domain examined, including which units cared for these infants and breastfeeding rates. Strikingly, the proportion of infants requiring pharmacotherapy ranged from 6.7% to 100% and hospital mean length of stay ranged from 2 to 28.8 days between centers. Although the authors found hospital differences in study populations, it seems implausible that individual patient factors could account for this level of variation. It is apparent that 2 decades into the present opioid crisis, and despite countless state and national efforts to improve quality of care for opioid-exposed infants, one of our nation’s most vulnerable populations is receiving highly variable care, resulting in disparate outcomes.

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