A Structural Examination of Racial Differences in Pharmacologic Treatment Among Opioid Exposed Infants.

objectivesPrevious work has shown racial/ethnic disparities in the receipt of pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This study examined disparities in receipt of screening and diagnosis of NOWS in addition to pharmacologic treatment.

methodsUtilizing electronic health record data from 2016 to 2022 from two large health systems in an urban Midwestern city, Non-Hispanic Black and Non-Hispanic White infants with birthing parents who had an opioid use diagnosis during pregnancy were sampled (N = 912). Data were analyzed using chi-squares, t-tests, and logistic regression analyses. Screening is defined as receipt of a Finnegan score, and Severe Finnegan score was defined as 2 scores ≥8 or 1 score ≥12.

resultsNon-Hispanic Black infants had 59% reduced odds of receiving a Finnegan score [95%CI OR = 0.41 (0.21,0.78)]. We observe no significant difference in receipt of a NOWS diagnosis by race/ethnicity after controlling for receipt of a Finnegan score. Conditional on being screened, Non-Hispanic Black infants had 58% reduced odds of receiving a severe Finnegan score [95%CI OR = 0.42 (0.23,0.76)] relative to Non-Hispanic White infants. In models controlling for receipt of a severe Finnegan score and a NOWS diagnosis, Non-Hispanic Black infants did not have significantly different odds of receiving pharmacologic treatment.

conclusionBlack infants with prenatal opioid exposure were screened for NOWS less often and had reduced odds of receiving a severe Finnegan score than their Non-Hispanic White counterparts. Screening and scoring inequities may contribute to downstream differences in pharmacologic treatment.