P2.H157: Rates of Emergency Department Visits in Neonates who Received Treatment for Neonatal Opioid Withdrawal Syndrome compared to Not Treated

Background: The continued overuse of opiates in America has been a major public health concern. Neonatal Opioid Withdrawal Syndrome (NOWS) or Neonatal Abstinence Syndrome (NAS) is a condition diagnosed in infants born to mothers with opioid/substance use disorder (OSUD). These infants present with a variety of neurologic, metabolic and respiratory symptoms. NOWS is diagnosed using one of various scoring systems, including Finnegan scoring system. Based on this scoring, pharmacological treatment may be given. In cases with low severity of NOWS, only non-pharmacological treatment is needed. Upon NICU discharge, infants with NOWS may continue to have conditions leading to the need for acute and emergency room (ER) care. These include, continued or worsening withdrawal symptoms, respiratory distress, fever, and gastrointestinal concerns. This retrospective study evaluated factors associated with ER/Acute care utilization in neonates with NOWS who were treated pharmacologically compared to those who were not.

Methods: Infants re admitted to our hospital with exposure to opiates alone or in addition to other substances in utero were included. Neonates were identified as those who were started on medication to control NOWS and those who received non-pharmacological treatment from electronic medical records (EPIC). ER utilization was assessed as an ER visit within 30 days and within 1 year of hospital discharge. Primary factors evaluated were hospital length of stay (LOS) and the type of treatment the neonate received in the hospital. Comparisons between the groups was done using Student t-test, Mann Whitney-U Test and Logistic Regression. The difference was considered significant at p< 0.05.

Results: The median LOS for the total sample of 293 infants with NOWS was 9 days and median last 5 Finnegan scores before treatment was 5.2. There were 162 (55%) infants not treated pharmacologically and 131 (45%) treated pharmacologically. Infants treated for NOWS had significantly longer LOS than non-treated infants (p < 0.001). Furthermore, infants treated for NOWS were more likely to have higher Finnegan scores (p < 0.001). Non-treated infants were more likely to have a negative meconium drug screen (p < 0.001) and urine drug screen (p = 0.004). Infants treated for NOWS were more likely to have acute care visits in the first 30 days in comparison to non-treated infants (p =0.03). There was no statistical significance between treated and non-treated infants in ER utilization in the first 30 days and 1 year after discharge, nor in the number of hospitalizations within 30 days or1 year after discharge.

Conclusion: ER utilization and hospitalization rates did not significantly change depending on need for NOWS treatment. There was higher acute care use 30 days after discharge in those treated for NOWS. Overall infants who were treated had longer LOS but this did not correlate with increased ER utilization or hospitalizations.