TOP 50 - National trends in NOWs management and outcomes before and after publication of Eat, Sleep, Console (ESC) approach: A 2004-2024 PHIS Cohort Study

Publication Number: 2802.TOP 50

Nashid H.. Chaudhury, Yale-New Haven Children's Hospital, New Haven, CT, United States; Frances Y.. Cheng, Yale University School of Medicine, New Haven, CT, United States; Matthew Grossman, Yale School of Medicine, New Haven, CT, United States

Background: Infants with in-utero opioid exposure are at high risk for neonatal opioid withdrawal syndrome (NOWs). The Eat, Sleep, Console (ESC) approach is superior to usual care for NOWs management, with evidence from both QI studies and a randomized control trial (RCT) demonstrating shorter length of stay (LOS), lower costs, and reduced pharmacologic utilization without adverse events. Although many hospitals adopted ESC (first proposed 2014), no national comparative analyses of LOS and pharmacologic utilization have been conducted since 2016. Furthermore, national NOWs incidence trends have not been studied since 2016. This current study explores associations between these key evidence-based publications and national trends in NOWs hospitalization LOS, cost, and pharmacologic use. This analysis provides a critical proxy for evidence-based practice adoption, offers insight into NOWs severity over time, and can inform targeted strategies to improve care for this vulnerable population.

Objective: Our primary objective was to analyze national LOS trends for infants with NOWs surrounding two key timepoints: (1) the 2014 introduction of the ESC approach and (2) the 2023 publication of the first ESC RCT. We also aimed to expand on national trends in NOWs incidence, pharmacologic utilization, and hospital costs from 2016 to 2024 using the Pediatric Health Information System (PHIS) database.

Design/Methods: We conducted a retrospective study using the PHIS database (50 children’s hospitals). Our primary outcome is LOS for infants with NOWs, compared to a control group of neonates admitted during the same periods. We will analyze LOS trends 2, 5, and 10 years surrounding the 2014 ESC introduction and 1 year surrounding the 2023 RCT. Secondary outcomes include hospitalization costs and pharmacologic utilization. Parallel analyses using local single-site data will be conducted to validate the PHIS administrative data. NOWs cases were identified via ICD-9/10 codes (779.5, P96.1) for admissions between 1/1/2004 and 12/31/2024. Controls were identified using normal newborn APR-DRG codes. Exclusion criteria included prematurity (gestational age < 37 weeks), birthweight < 1500g, multiple births, and pediatric complex chronic conditions. Following published methods, we excluded hospitals with fewer than 15 NOWs discharges or 150 non-NOWs birth discharges during the study period. Data acquisition is complete; analyses will be finished by 1/31. This study was deemed IRB-exempt.