Poverty tied to prolonged hospital stay for infants with neonatal opioid withdrawal syndrome

Reviewed by James Ives, M.Psych. (Editor)Jul 23 2019

For infants with neonatal opioid withdrawal syndrome (NOWS) due to prenatal opioid exposure, poverty is a risk factor for prolonged length of hospital stay, reports a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"These results suggest that excess length of stay may be the result of non-medical factors linked to poverty and that early allocation of resources for at-risk families may help to reduce the overall length of stay," according to the new research by Zachary A. Vesoulis, MD, and colleagues of Washington University School of Medicine, St. Louis.

Non-medical factors may explain poverty-related increases in length of stay

The study included 129 infants at risk of NOWS treated in the newborn ICU of an urban children's hospital between 2012 and 2017. Two-thirds of infants required morphine, alone or with other medications, to treat opioid withdrawal symptoms.

Fifty-two percent of patients came from urban/suburban communities and 48 percent from rural areas. Nearly 90 percent were on public insurance. Based on family income in the mother's ZIP code, 25 percent lived in "most disadvantaged" areas with high poverty rates. Only 16 percent of patients were black, but they were more likely to live in high-poverty areas. Poverty and other factors were analyzed for association with length of hospital stay.

The median hospital stay was 16 days. As in previous studies, infants who needed morphine treatment spent more time in the hospital: 23 versus eight days.

Poverty was strongly related to excess hospital stay: each one-point increase in the 0-to-100 Area Deprivation Index was associated with 0.13 extra days in the hospital. That was so even after controlling for morphine treatment, placement in state's custody, race, and gestational age at birth.

Race was the only other significant predictor: black infants averaged 2.8 more days in the hospital compared to white infants. "We speculate that infant race is serving as a secondary indicator of poverty," the researchers write.

While the study can't draw any conclusions about why poverty is associated with prolonged hospital stay in infants with NOWS, the researchers believe that "non-medical impediments to timely hospital discharge" play a role.

Possible barriers include lack of transportation to the hospital, inability to obtain essential infant care items such as car seats or cribs, inadequate childcare resources for other children in the home, access to postnatal care and/or medication treatment.

Leveraging all available social services at the time of the infant's admission to improve access to the hospital and resources to care for the infant at home is a clear target for reducing length of stay."

Zachary A. Vesoulis, MD and colleagues, Washington University School of Medicine, St. Louis

The study is among the first to look at how poverty and other social determinants of health affect differences in hospitalization outcomes of infants with NOWS, according to an editorial by Elisha M. Wachman, MD, of Boston Medical Center. "Future studies should focus on identifying key social determinants that impact NOWS clinical course," Dr. Wachman writes. She adds that the observed racial disparities "are important to understand for designing population-level interventions in order to improve the health of these maternal-infant dyads."