Graduation Year


Embargo Period


Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Alla Kushnir




Background: Neonatal Opiate Withdrawal Syndrome (NOWS) has been a concern in the United States, with an incidence of 20 cases per 1000 live births. Most research on NOWS uses length of stay (LOS) in the hospital or length of pharmacological treatment (LOT) as outcome measures for 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. Therefore, the aim of our research is to evaluate LOT and LOS, assessing what factors prolong hospital stay after completing pharmacological treatment for NOWS.

Objective: To evaluate factors that contribute to the difference between LOT and LOS.

Methods: A retrospective medical chart review of all neonates 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 over 35 weeks gestational age 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 is considered for LOS-LOT greater than 48 hours.

Results: 229 neonates were included in the study with median LOT 22 days and median LOS 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 is 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 the stay (p=0.929). Prolonged stay had no effect on readmission within 30 days (p=0.882). Mean LOS and LOT per year of birth were statistically different (p

Conclusions: Close to half of the babies treated for NOWS had a pronged LOS, most of which was due to a social hold or a hold by child protective services. The average cost of treatment for infants with NOWS is $79,937.75. By addressing underlying factors that prolong the stay in the hospital past medical care, we may be able to decrease medical spending and improve overall care for these neonates.



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