P0587 - Factors Impacting Length of Treatment and Length of Hospital Stay in Neonatal Abstinence Syndrome

Background: Neonatal Opiate Withdrawal Syndrome (NOWS) has been one of the complications of the opioid epidemic, with an incidence of 20 cases per 1000 live births in the United States. Most research on NOWS uses length of hospital stay (LOS) or length of pharmacological treatment (LOT) as outcome measures of treatment effectiveness. However, LOS does not account for other factors impacting neonatal care, such as other medical or social confounders. LOT may be a more precise measure to evaluate treatment effectiveness but does not account for possible need to continue close, in-hospital monitoring of withdrawal symptoms after termination of pharmacological treatment. Therefore, the aim of our research is to evaluate the difference between LOT and LOS, assessing what factors prolong hospital stay.

Objective: To evaluate factors that contribute to the difference between LOT and LOS after completion of pharmacological treatment for NOWS.

Methods: A retrospective medical chart review of all neonates over 35 weeks gestational age born to mothers with evidence of substance use/abuse from 2011 – 2017 at a tertiary care center was conducted by using EPIC EHR system. Neonates with in-utero opioid exposure and no other major congenital anomalies, who received pharmacological treatment for NOWS were included. Demographic data as well as outcome data related to the difference between LOT and LOS was analyzed using multivariate analysis. Prolonged hospital stay was considered for LOS-LOT greater than 48 hours.

Results: Total of 229 neonates were included in the study, with median LOT of 22 days and median LOS of 29 days. Of the 62% who had prolonged hospital stay after cessation of pharmacological treatment for NOWS, 43% were due to a hold placed by child protection service. There was a correlation in increased time between LOT and LOS and maternal age (p=0.001), as well as receiving treatment in the NICU (p=0.005). There was a trend towards a shorter stay in neonates with higher birth weight (p=0.05) and gestational age (p=0.08). Maternal polysubstance use did not statistically increase LOS (p=0.929). Prolonged stay had no effect on readmission within 30 days (p=0.882).

Conclusions: More than half of the babies treated for NOWS had a pronged LOS, with social hold or a hold by child protective services being the most frequent cause for the delay. The mean daily cost of treatment for infants with NOWS in the US is approximately $4996.1. By addressing factors that prolong hospital stay past time necessary for medical care, we may be able to decrease medical spending and improve overall care for these neonates.