Available online 28 January 2026, 103222

Author links open overlay panelKatherine E. Shedlock MD a, Neera K. Goyal MD MSc b c, Neera Shah Demharter MD b c g, Emily Gibbons MD a, Emily F. Gregory MD, MHS d, Jennifer M. McAllister MD e, Aaron R. Shedlock MD a, Erica M.S. Sibinga MD, MHS f, Jessica F. Rohde MD b c gShow moreAbstractObjective

Describe primary care pediatrician knowledge and confidence in caring for children affected by intrauterine opioid exposure (IOE) and neonatal opioid withdrawal syndrome (NOWS) and identify priorities for additional training.

Methods

We conducted a cross-sectional survey at seven U.S. children’s hospitals from April-June 2022. Eligible participants were pediatric attendings and pediatric residents practicing in primary care teaching clinics. Survey questions were adapted from prior studies of self-reported clinician knowledge and confidence and assessed clinician interest in additional training on various clinical topics related to IOE and NOWS. Frequencies were tabulated and chi-square comparisons were used to describe differences by demographics, practice setting, and patient population characteristics.

Results

Of 1004 invited clinicians, 329 (32.8%) responses were returned, of whom 324 were included in the final analytic sample. Most respondents (n=203, 62.7%) were residents, while 121 (37.4%) were attendings. One-third endorsed confidence that their training was sufficient to provide high quality primary care to children affected by IOE and NOWS, with no significant difference between residents (32.5%) and attendings (34.0%). Both residents and attendings desire further training in anticipatory guidance topics, such as feeding and gastrointestinal symptoms, breastfeeding recommendations, monitoring after Hepatitis C exposure, and neurodevelopmental outcomes of children with IOE.

Conclusions

Most pediatricians feel that their training has been insufficient to provide high quality primary care to infants affected by maternal opioid use. Additional training in graduate and continuing medical education aligned with pediatrician interest may enhance care for children with IOE and NOWS.

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Access through your organizationSection snippetsINTRODUCTION

Opioid use disorder (OUD) in pregnancy resulting in intrauterine opioid exposure (IOE) affects over 25,000 newborns annually.1 After initial assessment and management of neonatal opioid withdrawal syndrome (NOWS), infants with IOE require ongoing close primary care follow-up, with surveillance for neurodevelopmental, medical, and social concerns.2, 3, 4 Reflecting the specialized needs of this population, federal legislation now mandates that states require Plans of Safe Care (POSC), also known

Study Design

This was a cross-sectional, electronic, multi-site survey of pediatric primary care providers and residents at 7 U.S. children’s hospitals, conducted between April and June 2022. Referral sampling of hospitals aimed to provide representation from residency programs of varying size, U.S. geographic region, and practice settings. Pediatric attending physicians, residents, and advanced practitioners from outpatient primary care teaching sites at each residency program were invited to participate

RESULTS

Of 1,004 clinicians invited to participate from 28 primary care sites across 7 pediatric residency programs, 329 responded representing an overall response rate of 33%. Advanced practitioners (n=4) and respondents who did not indicate their clinical role (n=1) were omitted from the analysis to allow better estimation of findings by clinical background (i.e., attending versus resident). Of the remaining 324 respondents, most self-identified as resident physicians (62.7%) (Table 1). The

DISCUSSION

While prior studies have emphasized the importance of clinician knowledge in supporting infants with IOE within primary care, this study provides a comprehensive summary of pediatrician knowledge on multiple aspects of care for this population, identifying targeted areas for resident training and continuing medical education. We have previously described substantial variation in screening and referral practices, including a finding that only half of pediatricians routinely refer infants with

CONCLUSION

Most pediatricians lack confidence in providing high-quality primary care for infants with IOE and endorse knowledge gaps related to anticipatory guidance and local POSC requirements. Results suggest a need for more educational resources to support primary care of this population.

Funding

This project was supported by a grant to principal investigator Neera Goyal through Nemours Biomedical Research.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We acknowledge the contributions of our partnering residency programs and primary care offices as well as additional study team members: Dr. Davida Schiff, Dr. Jessica Ratner, Dr. Fateh Peera, and Dr. Christina Dorrian. We also thank our collaborators in survey development: Dr. Diane Abatemarco, Dr. Meghan Gannon, and Dr. Vanessa Short.

References (24)D.M. Schiff et al.Trainees' knowledge, attitudes, and practices towards caring for the substance-exposed mother-infant dyad

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J.F. Rohde et al.Pediatric primary care clinicians' views on needs and challenges in caring for infants with intrauterine opioid exposure and their families

J Child Health Care

(2024)

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