In December, the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) published its first ACT NOW Current Experience manuscript, “Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal,” in Pediatrics.

The ACT NOW (Advancing Clinical Trials in Neonatal Opioid Withdrawal) Current Experience Study is designed to describe variation in the care of infants with neonatal opioid withdrawal syndrome (NOWS). The data collected were used to inform two of the ACT NOW clinical trials which are currently enrolling and will shape policies, programs, and practices in the care of infants with NOWS.

This cross-sectional study of 1,377 infants with evidence of opioid exposure at 30 participating hospitals nationwide described variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS.

The study found that sites varied widely in the proportion of infants whose mothers received adequate prenatal care, medication-assisted treatment, and prenatal counseling. Sites also varied in the proportion of infants with toxicology screening and proportion of infants receiving pharmacologic therapy, secondary medications, and non-pharmacologic interventions, including fortified feeds and maternal breast milk. The mean length of stay varied across sites (from two to 29 days), as did the proportion of infants discharged with their parents.

The study concluded that the wide variation in characteristics and treatment makes it unlikely that all infants are receiving efficient and effective care for NOWS. The research suggests that this variation should be considered in future clinical trial development, practice implementation, and policy development.

“Understanding the current landscape of NOWS is critical for future research and the development of programs, policies, and practices to provide better care for these infants,” said Leslie Young, MD, of the University of Vermont. “The degree of variation among infants with NOWS observed in this study shows a significant opportunity to improve the care they receive.”

Also available is a commentary associated with the article, emphasizing the importance of ISPCTN’s work for the field.