Opioid prescribing patterns for hospitalized infants varies significantly by hospital and location, and the lack of standardization may put some infants at higher risk, according to a study released today by Children’s Hospital Los Angeles.
In the study published in JAMA Network Open, CHLA researchers found that the length of time the infants were prescribed opioids differed by geographic region across the United States — the Northeast, South, Midwest or West. Up to 16% of the variability in infant opioid prescriptions and 20% of the prescriptions for methadone — the medication used to help wean infants safely from opioids — depended on the individual hospital.
“Opioid prescribing patterns for adults have been well-studied, but this study is the first to examine inpatient opioid prescribing patterns in critically ill infants on a national scale,” Dr. Olivia A. Keane, lead author of the study, said in a statement. “Our study reports wide variation in opioid prescribing and thus exposure of infants to opioids across institutions.”
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Keane noted that the lack of standardized guidelines for opioid prescribing in infants can lead to significant differences in hospitalization length of stay, days on mechanical ventilation, days of IV nutrition, and can also impact health-care costs.
Researchers state in the study that appropriate dosing of opiates requires a delicate balance. There is the obvious clinical need to ease a baby’s pain, and without sufficient pain relief, infants can experience more complicated recoveries and poorer clinical outcomes after surgeries and intubation, according to CHLA researchers.
“Additionally, prolonged opioid exposure in high-risk hospitalized infants has been implicated in worsening neuro-developmental outcomes,” Keane said. “Thus, lack of standardization and the significant variation demonstrated by our study may put some infants at higher risk of poor long-term outcomes.”
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CHLA researchers and their collaborators conducted a retrospective study of 132,658 high-risk infants under 1 year old who were treated in 47 different children’s hospitals around the United States. The most common high-risk diagnosis was congenital heart disease (65%), while 30% of infants were born prematurely, and over half underwent surgery.
During their hospital stay, 76% of infants were prescribed opioids such as fentanyl, morphine and hydromorphone, and about 8% received methadone, the study shows.
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