Resource utilization and convalescent care cost in neonatal opioid withdrawal syndrome

Article type: Research Article

Authors: Ronan, K.^{a; b} | Hughes Driscoll, C.A.^a | Decker, E.^{a; c} | Gopalakrishnan, M.^d | El Metwally, D.^{a; *}

Affiliations: [a] Department of Pediatrics, University of Maryland School of Medicine, Maryland, USA | [b] Women’s and Babies Hospital, Lancaster, Pennsylvania, USA | [c] The College of Physicians and Surgeons at Columbia University, New York, USA | [d] Center for Translational Medicine, University of Maryland School of Pharmacy, Maryland, USA

Correspondence: [*] Address for correspondence: Dina El Metwally, MD, PhD, Division of Neonatology, 110 South Paca Street, 8th Floor Baltimore, MD 21201, USA. Tel.: +1 410 328 6003; Fax: +1 410 328 1076; E-mail: dmetwally@som.umaryland.edu.

Abstract: BACKGROUND:Neonatal opioid withdrawal syndrome (NOWS) is a growing public health problem associated with complex and prolonged medical care and a significant resource utilization burden. The objective of this study was to compare the cost of different convalescent care settings for infants with NOWS. METHODS:Retrospective comparison study of infants with NOWS discharged directly from NICU, transferred to an acute care pediatric floor (PPCU) or rehabilitation hospital (PRH). Primary outcomes were length of stay (LOS) and cost of stay (COS). RESULTS:Infants had 1.3 (95% CI: 1.1,1.6) times and 2.5 (95% CI: 2.1,3.1) times significantly longer mean LOS for PPCU and RH discharges compared to NICU discharges. NICU discharged infants had the lowest mean COS ($25,745.00) and PRH the highest ($60,528.00), despite PRH having a lower cost per day. PRH discharged infants had higher rates of methadone and benzodiazepine and less buprenorphine exposure than NICU/PPCU discharged. Infants born to mothers on marijuana and buprenorphine had a 28% lower mean COS compared to unexposed infants. Median treatment cumulative morphine doses were six-fold higher for PRH than NICU discharge. CONCLUSIONS:Infants transferred to convalescence care facilities had longer and more costly admissions and received more medication. However, there may be a role for earlier transfer of a subset of infants at-risk for longer LOS as those exposed to methadone and/or benzodiazepines. Further studies exploring differences in resource utilization, convalescent care delivery and cost expenditure are recommended.

Keywords: Convalescent care, neonates, opioid withdrawal, resource utilization

DOI: 10.3233/NPM-221060

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 49-57, 2023