Photo Credit: Iryna Inshyna

Infants with neonatal opioid withdrawal syndrome readmitted to the hospital were more likely to experience maltreatment, neglect, and physical abuse.

Infants born with neonatal opioid withdrawal syndrome (NOWS) are at increased risk of 90-day hospital readmissions for trauma and maltreatment compared with other newborns, according to a study published online 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,” wrote corresponding author Julie R. Gaither, PhD, MPH, RN, and study coauthors.

The researchers explained that the study is the first to investigate hospital readmissions for infants with NOWS despite a five-fold increase in cases over the past two decades. The analysis focused on US hospital discharge records for the years 2016 to 2020 from the Nationwide Readmissions Database for more than 13.8 million newborns. Among this sample, 89,018 (0.6%) were diagnosed with NOWS.

Readmission Outcomes in Infants With NOWS

The study found that 90-day all-cause readmission rates were 4.2% for infants with NOWS compared with 3.0% for infants without NOWS. After adjustment for sex, low birth weight, gestational age, multiple gestation, insurance type, and year of birth, the odds ratio (OR) for all-cause readmission was 1.18 for infants with NOWS.

Compared with infants without NOWS, infants with NOWS had significantly higher odds of readmissions for falls from furniture or someone’s arms (researchers reported a 5.30 adjusted OR), skull fractures (3.72), any head injury (3.43), anoxic brain injury or asphyxia (3.28), traumatic brain injury (2.95), failure to thrive (1.99), and seizures (1.58), according to the study.

Upon readmission, the likelihood of a diagnosis of confirmed maltreatment was also higher for infants with NOWS. Adjusted ORs were 4.26 for maltreatment and 14.18 for neglect, specifically, compared with other infants. The study also found a 2.42 OR for physical abuse for infants with NOW, but the finding was not statistically significant.

Among 412,320 readmitted infants, mortality rates during readmission were 0.8% for infants with NOWS and 0.4% for infants without NOWS. Researchers found no significant difference in mortality odds between the two groups.

“Given the complex challenges that families affected by maternal opioid use face once they leave the hospital with their newborns, further investment in the expansion of home-based models of care that focus concurrently on substance use treatment, parenting support, and early intervention services might benefit both mother and child,” Dr. Gaither and colleagues wrote.