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Symptom-based dosing shortened discharge readiness time in NOWS

Research area:MedicinePediatrics, Perinatology and Child HealthPediatric Pain Management Techniques

What the study found

Symptom-based dosing for infants with neonatal opioid withdrawal syndrome (NOWS) led to a shorter time to medical readiness for discharge than a scheduled opioid taper among infants cared for with Eat, Sleep, Console (ESC), a care approach that focuses on whether infants can eat, sleep, and be consoled.

Why the authors say this matters

The authors conclude that symptom-based dosing may better align opioid treatment with withdrawal severity, and the findings indicate it reduced time to medical readiness for discharge in the ESC setting.

What the researchers tested

In a cluster crossover randomized clinical trial at 23 US hospitals, infants at least 36 weeks' gestation and at risk for pharmacologic treatment were assigned to symptom-based dosing or scheduled opioid taper, using site-specific opioid algorithms. Hospitals used either ESC or Finnegan-based care, a symptom scoring system for withdrawal severity, and each site used its preferred primary opioid.

What worked and what didn't

In the ESC cohort, time to medical readiness for discharge was shorter with symptom-based dosing than with scheduled taper (9.18 vs 11.61 days; adjusted mean ratio 0.79). There was no difference in initiation of pharmacologic treatment or length of stay, and 35% of infants in the symptom-based group still needed scheduled opioid dosing because intermittent dosing did not control withdrawal severity. In the Finnegan cohort, there were no significant differences in time to medical readiness for discharge or length of stay.

What to keep in mind

The abstract reports that the inpatient composite safety outcome occurred rarely, but it does not provide a fuller safety discussion here. The main positive finding was reported for infants cared for with ESC, while the Finnegan cohort did not show significant differences.

Key points

  • Symptom-based dosing shortened time to medical readiness for discharge in infants cared for with ESC.
  • In the ESC cohort, readiness for discharge was 9.18 days with symptom-based dosing versus 11.61 days with scheduled taper.
  • There was no difference in starting pharmacologic treatment or in length of stay in the ESC cohort.
  • Thirty-five percent of infants in the symptom-based group needed scheduled opioid dosing because intermittent dosing was not enough.
  • In the Finnegan cohort, there were no significant differences in readiness for discharge or length of stay.

Disclosure

Research title:
Symptom-based dosing shortened discharge readiness time in NOWS
Authors:
Lori A. Devlin, Denise C. Babineau, Stephanie L. Merhar, Sara B. DeMauro, Walter K. Kraft, Scott A. Lorch, Abhik Das, Scott A. McDonald, E. Leeon Rhodes, Augusto F. Schmidt, Lillian Trochinski, Margaret Crawford, Thitinart Sithisarn, Lawrence Leeman, Kelley Kovatis, Namasivayam Ambalavanan, Ryan Smith, Sucheta Telang, Jennifer A. Tioseco, Jennifer M. McAllister, Scott L. Wexelblatt, Bhanu Muniyappa, Patricia K. Williams, Susan Adeniyi-Jones, Crystal D. Hill, Tanner Wright, Gregory M. Sokol, Lynette Johnson, Richard W. Hall, Scott D. Duncan, Karen Puopolo, Krishna Dummula, Ann Anderson-Berry, Jonathan M. Davis, Brenda Poindexter, Leslie W. Young, Crystal Bass, Elizabeth Hendricks, David Paul, Jennifer Chambers, Amy Mackley, Ward Rice, Cathy Grisby, David Russell, Lisa Tully, Traci Beiersdorfer, Carla King, Cynthia Reid, Stephanie Wilson Archer, Henrietta Bada, Mina Hanna, Amanda Wilburn, Susan DeGraaff, Beth McKinney-Whitlock, Carrie Hobbs, Crystal Wilson, Anna E. Thomas, Hannah Rakow, Jessica Mendoza, Betsy Tudor, Loren Nallu, Mary Connolly, Allison Dymacek, Karen Herzing, Natalie Goodman, Erin Bohon, Aprill Shockley, Emily Smith, Jenny Auman, Anna Mazur, Shannon Barnes, Brittany Thomas, Eugene Turner, James Pickett, D Leblond, Savannah Moore, Courtenay Fulmor, Lisa Pullaro, Emily J. Murray, Megan Lennon Kundrat, Angela Pallotto, Melette Pearson, Myriam Peralta-Carcelen, Waldemar A. Carlo, Samuel Gentle, Sandra Turner, Rachel Benz, Sharon Owen, Vallon Williams, Allyson Cheathem, A. Keyes, Kristina Foster, Allison Scott, Madison Jessie, Sarah Morris, Jennifer Nason, Audrey Miller, Rachel Welch-Miles, Molly Hemmerle, Betty Oberle, Matt VanOrmer, Sarah Newman, Emilee Kendall, Kym Abraham, Sofia M Markee, Nicole Yonke, Jessie Maxwell, Sandra Beauman, Conra Lacy, Ashley Palmer, Elizabeth Kuan, Megan Dhawan, Mary Catherine Gambacorta, Jon Snyder, Melanie Risch, Hanna Rosewood, Ronnie Guillet, Julie Riccio, Melissa Moreland, Rachel Jones, Marcia Kneusel, Courtney Casey, Robin K. Ohls, Camille Fung, Carrie A. Rau, Kathie Coleman, Kandace M. McGrath, Manndi C. Loertscher
Institutions:
AtlantiCare, Children's Hospital of Oklahoma, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia, Children's Mercy Hospital, Christiana Care Health System, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Emory University, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Golisano Children's Hospital, Good Samaritan Hospital, Indiana University – Purdue University Indianapolis, Indiana University School of Medicine, Mercy Hospital, Norton Hospital, Norton Hospital, Norton Women's and Children's Hospital, Perinatal Institute, Perinatal Institute, Perinatal Institute, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI International, RTI International, RTI International, RTI International, RTI International, RTI International, St. Elizabeth Healthcare, Thomas Jefferson University, Thomas Jefferson University, Tufts Medical Center, University of Alabama at Birmingham, University of Arkansas for Medical Sciences, University of Kansas Medical Center, University of Louisville, University of Louisville Hospital, University of Nebraska Medical Center, University of New Mexico, University of Oklahoma Health Sciences Center, University of Pennsylvania, University of Pennsylvania, University of Pennsylvania, University of Rochester, University of South Florida, University of Utah, University of Vermont
Publication date:
2026-04-25
DOI:
10.1001/jama.2026.5782
OpenAlex record:
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AI provenance: This post was generated by OpenAI. The original authors did not write or review this post.

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