Prescribing Newborns Opioids, Methadone Varies Significantly Across Children’s Hospitals

From 2016 to 2022, researchers found a significant number of opioid and methadone prescriptions across 47 individual children’s hospitals. Although opioid prescriptions were more significant than methadone, researchers came to the suggestion that a standardized approach to treating high-risk newborns is necessary for overall health outcomes.

“Infants exposed to painful procedures experience acute physiologic responses and increased morbidity, and opioids reduce these poor outcomes. However, extended opioid prescribing after surgery is associated with prolonged ventilation, total parenteral nutrition use, and hospitalization. Furthermore, higher cumulative opioid exposure is associated with impaired neurodevelopment, including impaired cerebellar growth, developmental disability, and poor socialization. Ultimately, regional and hospital-level differences in hospitalized infants’ opioid exposure may have significant effects on both short- and long-term clinical outcomes,” wrote authors of the study published in JAMA Network Open.¹

With most newborn opioid exposures occurring in a hospital setting, researchers wanted to measure the extent of prescriptions for both opioids and methadone specifically in children’s hospitals across the US.

In this retrospective cohort study, researchers analyzed data from 132,658 high-risk infants hospitalized in 47 children’s hospitals across the country. Observing data from the beginning of 2016 through the end of 2022, they separated each patient into 4 US regions: Northeast, South, Midwest, and West. The median gestational age of patients was 34 weeks, 54.5% were boys, and all participants were under 1 year at the time of hospital admission.

Researchers found that high-risk infants were prescribed several different opioids across US hospitals; 76.5% were prescribed opioids. Of all opioids prescribed to study participants, 66.5% were exposed to fentanyl, 60.6% morphine, 5.8% hydromorphone, and 7.9% methadone. Regarding the geographical layout of the results, opioid prescriptions were above 71% for all 4 regions, with the West prescribing the most opioids at 81.2% of all study patients.

“We found that most received opioids during hospitalization with wide variation across US regions and between hospitals. Furthermore, 16% of the variability in any opioid prescribing and 20% of the variability in methadone treatment was attributable to the individual hospital,” continued the authors.

The researchers’ findings showed significant success in the study with the aim of quantifying the variation in opioid prescriptions across US children’s hospitals. From 16% variability in opioid prescriptions overall to a 20% variability for methadone prescriptions, prescribing methods and protocols for high-risk newborns were staggered across the US.

Similar to a previous study analyzing opioid dosing, researchers suggest a more standardized approach to prescribing pain management therapies for high-risk infants.

“In this case-control study, a positive association was found between total prescription opioid dose dispensed and the odds of spontaneous preterm birth. These findings support guidance to minimize opioid exposure during pregnancy and prescribe the lowest dose necessary,” wrote Bosworth et al.²

While Keane et al’s study focuses on the general variability, both studies clearly highlight the complexities of prescribing opioids to high-risk newborns.

Each infant included in the study reported various comorbidities; 65.5% had congenital heart disease, 30.3% experienced prematurity, and 55.3% of infants underwent a procedural intervention. Demographics were also staggered, further owing to the sheer variation among study results.¹

While researchers gave no suggestions into what a standardized approach would look like, they stated that it’s necessary to ensure a satisfactory balance of keeping high-risk newborns at a minimal amount of pain without negatively affecting their development.

“Institution-level variation in overall opioid prescribing and methadone treatment in high-risk hospitalized infants persists across US children’s hospitals. These findings highlight a need to develop standardized evidence-based protocols to manage procedural pain, prolonged intubation, and surgical recovery for high-risk infants,” concluded the authors.¹

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References

1. Keane OA, Ourshalimian S, Lakshmanan A, et al. Institutional and regional variation in opioid prescribing for hospitalized infants in the US. JAMA Netw Open. 2024;7(3):e240555. doi:10.1001/jamanetworkopen.2024.0555

2. Bosworth OM, Padilla-Azain MC, Adgent MA, et al. Prescription opioid exposure during pregnancy and risk of spontaneous preterm delivery. JAMA Netw Open. 2024;7(2):e2355990. doi:10.1001/jamanetworkopen.2023.55990