The goal of this observational study is to learn how two medicines used in routine care-buprenorphine and morphine-affect recovery in newborns (≥36 weeks' gestation) with Neonatal Opioid Withdrawal Syndrome (NOWS). The main questions it aims to answer are: 1. Do infants treated with buprenorphine become medically ready for discharge sooner than those treated with morphine? 2. Does one treatment lead to better overall clinical outcomes than the other? Researchers will compare infants who received buprenorphine with infants who received morphine to see whether one treatment helps babies recover more quickly. Participants will not be asked to do anything. Instead, the study team will collect information already documented in the infant's and mother's medical records securely without any contact or changes to clinical care. No new medicines, procedures, or visits are involved. This study only reviews existing clinical data to better understand which commonly used treatment may support faster recovery for newborns with NOWS.
Neonatal Opioid Withdrawal Syndrome (NOWS) occurs in infants who were exposed to opioids during pregnancy and may lead to symptoms such as irritability, feeding difficulties, and trouble sleeping. Many hospitals treat these symptoms with either morphine or buprenorphine, but it is not yet known whether one medication helps infants recover more quickly. This study aims to answer that question by reviewing information already documented in medical records from hospitals that routinely use one of these treatments. The study will include approximately 796 infants, all born at 36 weeks' of gestation or later and treated for NOWS with either buprenorphine or morphine as part of usual clinical care. Data will be collected from about 22 hospitals across the United States. Researchers will review existing medical record information such as the infant's birth characteristics, withdrawal symptoms, details of treatment (including medication choice and dosing approach), feeding practices, non-pharmacologic care, and clinical outcomes-including the key measure of how long it took for the infant to become medically ready for discharge. Because treatment decisions are made by the clinical team and not assigned by the study, researchers will use advanced statistical methods to compare outcomes between infants who received buprenorphine and those who received morphine. These methods allow the team to adjust for differences between infants and hospitals, helping ensure that comparisons are as fair and accurate as possible. The goal is to estimate how outcomes would differ if all infants received one medication versus the other in real-world practice. No infants or parents will be contacted for this study, and no additional treatments, tests, or procedures will be performed. All data come from routine clinical care. The regulatory review for this project determined that informed consent from families is not required because the study uses only existing medical information and does not involve any interaction with participants or changes to medical care. All collected data will be handled securely and in compliance with federal privacy requirements. The information learned from this research may help improve care for future infants with NOWS by providing clearer evidence on how commonly used treatments compare in supporting recovery.
Study Type
OBSERVATIONAL
Enrollment
796
University of Alabama at Birmingham
Birmingham, Alabama, United States
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
ChristianaCare
Wilmington, Delaware, United States
University of South Florida Health
Tampa, Florida, United States
Riley Hospital for Children at IU Health
Indianapolis, Indiana, United States
Sidney & Lois Eskenazi Hospital
Indianapolis, Indiana, United States
University of Louisville Hospital
Jeffersonville, Indiana, United States
St. Elizabeth Healthcare
Edgewood, Kentucky, United States
Kentucky Children's Hospital
Lexington, Kentucky, United States
Norton Children's Hospital
Louisville, Kentucky, United States
...and 12 more locations
Time from birth until infant meets criteria for medically ready for discharge (count)
Number of days from birth until infant meets criteria for medically ready for discharge. An infant is considered medically ready for discharge when they are discharged by the medical provider or when they meet both of the following criteria: * 96 hours of age * 48 hours since last dose of treatment with morphine or buprenorphine
Time frame: From date of birth until date of infant meeting criteria for medically ready for discharge (estimated to be < 90 days).
Length of hospital stay (count)
Number of days between birth and hospital discharge
Time frame: From date of birth until date of hospital discharge (estimated to be < 90 days).
Length of primary opioid treatment (count)
Number of days between the first and the last primary opioid dose administered
Time frame: From date of birth until date of last primary opioid dose administration (estimated to be < 90 days).
Number of primary opioid doses administered (count)
Number of primary opioid doses administered (count)
Time frame: From date of birth until date of last primary opioid dose administration (estimated to be < 90 days).
Receipt of secondary medication (binary)
Receipt of at least one dose of any amount of phenobarbital, clonidine, or some other non-opioid medication as a secondary medication
Time frame: From date of birth until date of first non-opioid secondary medication administration or until date of hospital discharge, whichever comes first (estimated to be < 90 days).
Inpatient composite safety outcome (binary)
Occurrence of at least one of the following events between birth and the last primary opioid dose administered: * Seizures * Excessive weight loss more than 15% from birthweight
Time frame: From date of birth until date of first occurrence of seizure or excessive weight loss more than 15% from birthweight or until date of last primary opioid dose administration, whichever comes first (estimated to be < 90 days).
Inpatient composite critical safety outcome (binary)
Occurrence of at least one of the following events between birth and the last primary opioid dose administered: * Non-accidental trauma * Death
Time frame: From date of birth until date of first occurrence of non-accidental trauma or death or until date of last primary opioid dose administration, whichever comes first (estimated to be < 90 days).
Inpatient composite safety outcome after receipt of pharmacologic treatment (binary)
Occurrence of at least one of the following events between first primary opioid dose administered and the data of hospital discharge: * Seizures * Excessive weight loss more than 15% from birthweight
Time frame: From date of first primary opioid dose administration until date of first occurrence of seizure or excessive weight loss more than 15% from birthweight or until date of hospital discharge, whichever comes first (estimated to be < 90 days).
Inpatient composite critical safety outcome after receipt of pharmacologic treatment (binary)
Occurrence of at least one of the following events between first primary opioid dose administered and hospital discharge: * Non-accidental trauma * Death
Time frame: From date of first primary opioid dose administration until date of first occurrence of non-accidental trauma or death or until date of hospital discharge, whichever comes first (estimated to be < 90 days).
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