Effect of neonatal intensive care unit design on infants with Neonatal Opioid Withdrawal Syndrome

Background/ObjectiveNeonatal Opioid Withdrawal Syndrome (NOWS) requires advanced and often prolonged medical care in the neonatal intensive care unit (NICU). We examined the effect of NICU design on treatment and NICU length of stay (NICU-LOS) for infants with NOWS.MethodsA retrospective chart review of eligible infants with NOWS was conducted from 2013 to 2018. We collected and analyzed data on demographics, medication, and NICU-LOS characteristics. A multivariable linear regression on log-transformed NICU-LOS was performed for comparison between the open-bay design (OBD) for 2013-2015 (August) and the new single-family-room (SFR) NICU for September 2015-2018.ResultsThere were 118 neonates analyzed in OBD and 138 neonates in the SFR. Among infants in the SFR NICU, 86% received pharmacotherapy, compared to 76% of infants in the OBD (<i>p</i> = 0.059). The breastfeeding rate was 26% in the SFR and 6% in the OBD (<i>p</i> =< 0.001 ). Infants in the SFR NICU had 1.3 times longer mean NICU-LOS (<i>p</i> = 0.0163) than infants in OBD after adjusting for covariates including small for gestational age. The median (1Q, 3Q) cumulative doses of morphine (mg/kg) among the SFR and OBD groups were 6.4 (2.3,17.3) and 8.7 (3.2,19.3) <i>p</i>: NS, respectively.ConclusionsThe SFR NICU was associated with longer NICU-LOS for infants with NOWS despite higher rates of breastfeeding and no difference in morphine dosage. While providing more privacy and possible improved patient satisfaction, there may be unintended consequences of the SFR design.