165 - Variation in Modified Finnegan Scoring of Neonatal Opioid Withdrawal Syndrome in the Neonatal Intensive Care Unit

Poster Number: 165
Publication Number: 165.411

Katherine Nyman, University of Maryland Children's Hospital, Washington, DC, United States; Francesca Okolie, University of Maryland Children's Hospital, Baltimore, MD, United States; Erin Hager, University of Maryland School of Medicine, Baltimore, MD, United States; Dina El-Metwally, University of Maryland School of Medicine, Baltimore, MD, United States

Background: Racial bias is prevalent in healthcare, with harmful effects on both children and adults. Neonatal opioid withdrawal syndrome (NOWS) is characterized by newborn withdrawal from in utero drug exposure, and the modified Finnegan score (MFS), a subjective assessment tool, is used to determine the need for opiate intervention in NOWS. At present, there are no current studies evaluating the impact of racial bias in the assessment and treatment of NOWS.

Objective: Our study sought to determine if implicit bias among nurses leads to differences in MFS between black and white infants.

Design/Methods: Study participants were volunteers recruited from the neonatal intensive care unit at a large tertiary referral center. Informed consent was obtained prior to enrollment; participants were blinded to the objective of the study. Three clinical vignettes depicting infants with NOWS were developed into an electronic survey (RedCap). Participants received all three vignettes and a photo of either a black or white infant, with randomization at the time of recruitment. Demographic data including, age, years of practice, and self-reported race/ethnicity were collected. Paired t-test was used to compare mean MFS and Pearson’s chi-squared test was used to compare the proportion of infants with MFS ≥9, the institutional cutoff for receiving morphine. The study was performed with approval from the institutional review board.

Results: The survey was completed by 47 nurses; 81% were white, 8.5% black, 4.3% Asian, and 6.4% did not disclose. In total, 28 survey respondents were assigned a black infant, and 19 were assigned a white infant. There were no significant differences between the mean MFS between the two groups. For the vignette depicting the most serious NOWS symptoms, the mean MFS among white infants was 9.05 (standard deviation [SD] = 1.22), and among black infants was 8.54 (SD = 1.75, P = 0.058). For the same vignette, MFS score ≥9 was given in 79% of white infants and 54% of black infants (P = 0.076).Conclusion(s): In this small study, there was no significant racial difference in MFS scoring. There was a nonsignificant trend towards lower withdrawal scoring for black infants compared to white infants with more serious NOWS symptoms. More data is warranted to determine the presence of racial bias in MFS administration.
Table 1: Demographic Data From Completed Surveys
Figure 1: Modified Finnegan Score MeansMFS= Modified Finnegan Score. Whiskers represent standard deviation from the mean.