Background: As opioid use continues to rise in the US, providers care for infants who suffer from Neonatal Opioid Withdrawal Syndrome (NOWS). NOWS has potential adverse psychosocial and developmental outcomes in these children. To mitigate these effects, current guidelines recommend evaluation and follow up with multiple services including therapists, Developmental Pediatrics, Early Intervention, Home Health, and Pediatric Ophthalmology. As the care focus is on supporting these infants and their families through the initial withdrawal period, inpatient consults and outpatient referrals may be overlooked.
Methods: This was a single center, QI initiative that began data collection via retrospective chart review of infants with NOWS in 2023. Infants born less than 34 weeks gestational age or with congenital pathology were excluded. The study aimed to determine whether a NOWS order set could increase inpatient referrals to crucial services such as physical therapy (PT), occupational therapy (OT) and speech therapy, as well as social work. We subsequently developed a discharge flowsheet to ensure that all infants had the appropriate outpatient referrals in place prior to discharge.
Results: PT/OT referrals and speech therapy referrals were 40.6% and 52.7% before the order set introduction in July 2024. After the order set was introduced, referrals increased to 94.1% and 90.5%, respectively. Use of the discharge checklist starting in April 2025 has had a positive impact on Ophthalmology referrals, up from 15.5% to 35.8% to date.
Conclusions: The introduction of the order set increased the number of referrals made for key services. The discharge checklist has not yet shown a consistent increase in referrals; more education on its use is needed. Implementing order sets and discharge checklists can be important tools in promoting optimal long-term outcomes in infants with NOWS.
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