New Research: A Better Way to Track Neonatal Opioid Withdrawal Syndrome
Published in BMC Pediatrics, August 2026
About This Study
Neonatal Opioid Withdrawal Syndrome (NOWS) — which occurs in newborns exposed to opioids in utero — remains a significant and growing public health challenge in the U.S. But how accurately we measure it depends on which diagnostic codes we use. Most national surveillance has relied on a single ICD-10-CM code (P96.1). Our study asked whether a dual code approach — combining P96.1 with exposure code P04.49 — gives a more complete picture.
Our Findings
What We Did and What We Found
Using 2016–2022 data from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database, the largest national pediatric inpatient database in the U.S., we compared NOWS prevalence under both approaches in newborns ≥35 weeks gestational age, and examined how estimates varied by race/ethnicity, insurance type, income level, and rural vs. urban setting.
What we found:
- The dual code approach captured roughly twice as many NOWS cases overall (19.05 vs. 9.48 per 1,000 birth hospitalizations)
- Rural hospitals had the highest prevalence with dual codes (33.22/1,000) — more than double the single-code estimate (13.88/1,000)
- Medicaid-insured infants showed similarly elevated rates (35.93 vs. 18.12/1,000)
- Black infants showed nearly a three-fold increase in prevalence with dual codes (19.67 vs. 6.19/1,000) — a disparity largely invisible with the single-code approach
- Overall prevalence declined from 2016–2022 under both methods, with a modest uptick in 2021 during the COVID-19 pandemic
- Short-term morbidity risk was higher with the dual code approach (15.2% vs. 6.2%), while length of stay was longer with the single-code approach (11.7 vs. 7.0 days)
Taken together, our findings suggest that the dual code approach offers consistent estimation and better discrimination of NOWS — relative trends across sociodemographic groups held up similarly regardless of which codes were used, while the dual approach more clearly separated out absolute disparities and effect modification across race/ethnicity, payer type, income level, and rural vs. urban status. That combination makes it a promising complementary strategy for surveillance.
Why it matters: How we count NOWS cases shapes how resources are allocated, how disparities are understood, and how policies are designed. Undercounting — particularly among Black infants, rural communities, and low-income families — risks misallocating support for some of the most vulnerable newborns. We endorse universal opioid screening during pregnancy, consistent with ACOG recommendations.
Authors: Janine Khan (Department of Pediatrics, Neonatology, Ann & Robert H Lurie Children's Hospital of Chicago), Hannah Neuman, James Groh, Phoebe Troeller (Zilber College of Public Health, University of Wisconsin-Milwaukee); Marina Feffer (Loyola University Chicago Stritch School of Medicine); Chariya Christmon (Department of Pediatrics, Hospital-Based Medicine, Ann & Robert H Lurie Children's Hospital of Chicago); Keith Dookeran (Zilber College of Public Health, UW-Milwaukee; SIU School of Medicine, Population Science and Policy)
Read the full open-access paper: https://doi.org/10.1186/s12887-026-07015-x
Keith Dookeran, co-author