Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, Vermont;
Departments of Biostatistics and.
Pediatrics. 2021 Jan;147(1). doi: 10.1542/peds.2020-008839. Epub 2020 Dec 21.
Variation in pediatric medical care is common and contributes to differences in patient outcomes. Site-to-site variation in the characteristics and care of infants with neonatal opioid withdrawal syndrome (NOWS) has yet to be quantified. Our objective was to describe site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS.
Cross-sectional study of 1377 infants born between July 1, 2016, and June 30, 2017, who were ≥36 weeks' gestation, with NOWS (evidence of opioid exposure and NOWS scoring within the first 120 hours of life) born at or transferred to 1 of 30 participating hospitals nationwide. Site-to-site variation for each parameter within the 3 domains was measured as the range of individual site-level means, medians, or proportions.
Sites varied widely in the proportion of infants whose mothers received adequate prenatal care (31.3%-100%), medication-assisted treatment (5.9%-100%), and prenatal counseling (1.9%-75.5%). Sites varied in the proportion of infants with toxicology screening (50%-100%) and proportion of infants receiving pharmacologic therapy (6.7%-100%), secondary medications (1.1%-69.2%), and nonpharmacologic interventions including fortified feeds (2.9%-90%) and maternal breast milk (22.2%-83.3%). The mean length of stay varied across sites (2-28.8 days), as did the proportion of infants discharged with their parents (33.3%-91.1%).
Considerable site-to-site variation exists in all 3 domains. The magnitude of the observed variation makes it unlikely that all infants are receiving efficient and effective care for NOWS. This variation should be considered in future clinical trial development, practice implementation, and policy development.
儿科医疗服务的变异性很常见，这导致了患者结局的差异。新生儿阿片类戒断综合征（NOWS）婴儿的特征和护理在不同地点之间的差异尚未被量化。我们的目的是描述不同地点之间患有 NOWS 的母婴特征、婴儿管理和结局的变异性。
这是一项全国范围内的横断面研究，纳入了 2016 年 7 月 1 日至 2017 年 6 月 30 日之间出生的 1377 名胎龄≥36 周的婴儿，他们有 NOWS（在生命的前 120 小时内有阿片类药物暴露和 NOWS 评分），并在全国 30 家参与医院中的一家出生或转来。3 个领域内的每个参数的地点间变异性通过个体地点水平的平均值、中位数或比例的范围来衡量。
在母亲接受充分产前护理的婴儿比例（31.3%-100%）、药物辅助治疗（5.9%-100%）和产前咨询（1.9%-75.5%）方面，各医院差异很大。毒物筛查的比例（50%-100%）和接受药物治疗的婴儿比例（6.7%-100%）、二线药物（1.1%-69.2%）以及非药物干预（包括强化喂养（2.9%-90%）和母亲的母乳（22.2%-83.3%））方面，各医院也存在差异。各医院的住院时间长短不一（2-28.8 天），父母出院的婴儿比例也不同（33.3%-91.1%）。
所有 3 个领域都存在相当大的地点间变异性。观察到的变异性程度很大，这使得不太可能所有婴儿都接受针对 NOWS 的高效和有效的治疗。在未来的临床试验开发、实践实施和政策制定中，应考虑这种变异性。
