Observational studyPediatrics2021
Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal.
Observational study in Pediatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 47 citations in OpenAlex.
- Accelerated Weaning of Opioids to Reduce Pharmacologic Exposure for Neonatal Opioid Withdrawal Syndrome: A Randomized Clinical Trial.The Journal of pediatrics · 2026Trial
- Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal.The New England journal of medicine · 2023Trial
- Association between NNNS-II profiles and pharmacological treatment in infants with prenatal opioid exposure.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Modeling heart rate patterns to quantify neonatal opioid withdrawal syndrome.Pediatric research · 2026Article
- Interventions to reduce pharmacologic opioid exposure in neonatal opioid withdrawal syndrome: a systematic review and meta-analysis of randomized studies.Frontiers in pain research (Lausanne, Switzerland) · 2026Review
- Association between NNNS-II Profiles and Pharmacological Treatment in Infants with Prenatal Opioid Exposure.Research square · 2025Article
- Prenatal Substance Exposure and Infant Discharge Placement: Results From the ACT NOW Study.Child maltreatment · 2025Article
- Article
- Article
- Buprenorphine vs. morphine: impact on neonatal opioid withdrawal syndrome (NOWS) outcomes in a single center retrospective study.Journal of perinatology : official journal of the California Perinatal Association · 2025Article
- Prediction of site-specific pharmacologic therapy among newborns with neonatal opioid withdrawal syndrome.Journal of perinatology : official journal of the California Perinatal Association · 2025Article
- Comparing Medical Record Abstraction (MRA) error rates in an observational study to pooled rates identified in the data quality literature.BMC medical research methodology · 2024Observational
- The Cost of Opioid Use in High-Risk Hospitalized Infants.The Journal of surgical research · 2024Article
- Integrating a Parenting Assessment into Practice: Pediatric Providers' Time and Perspectives.Maternal and child health journal · 2024Article
- Considerations and Determinants of Discharge Decisions among Prenatal Substance Exposed Infants.Child maltreatment · 2024Article
- Institutional and Regional Variation in Opioid Prescribing for Hospitalized Infants in the US.JAMA network open · 2024Article
- Opioids in Hospitalized Infants-Managing Pain and Sedation While Avoiding Overuse.JAMA network open · 2024Article
- A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome.Children (Basel, Switzerland) · 2023Review
- Neonatal opioid toxicity: opioid withdrawal (abstinence) syndrome with emphasis on pharmacogenomics and respiratory depression.Archives of toxicology · 2023Review
- The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome.Maternal and child health journal · 2023Article
Corrections and comments
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Authors and funding
26 authors at 20 institutions in 2 countries.
Funding
Abstract
BACKGROUND AND
objectivesVariation 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.
methodsCross-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.
resultsSites 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%).
conclusionsConsiderable 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.