Missed Nursing Care in Neonatal Intensive Care Units for Infants Experiencing or at Risk of Experiencing Substance Withdrawal.
Sooyoung Kim, Adam C Carle, Rita Pickler and 2 others
PMID 42397103WHAT IT FOUND
Across 894 of 11,807 NICU shifts, infants that nurses reported as having or at risk for withdrawal were more likely to have missed nursing care, especially pain checks, airway tube checks, developmental care, and high-risk drug assessments.
It does not show withdrawal caused missed care.
Key findings
01Infants reported as experiencing or at risk for withdrawal were 1.6 times more likely to have any missed nursing care (OR = 1.57).
02They were 2.3 times more likely to have missed pain assessment per protocol (OR = 2.29).
03Withdrawal status was not significantly associated with missed IV site assessment, feeding-related practices, infection prevention, or parent-related support activities.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational and measured associations at the same shift, so it cannot show that withdrawal caused missed nursing care. Withdrawal status and missed care were both reported by nurses, with no standardized withdrawal tool or diagnostic criteria, so reporting bias and social desirability are possible. Nurses were recruited by convenience sampling, and when a nurse had more than two infants, only the two highest numbered bed spaces were reported. Missed care was dichotomized, and rarely missed responses were counted as missed, so some findings may reflect minor omissions rather than serious care failures. Missing data were handled by listwise deletion, with 11.7% to 16.1% missing depending on the model. The study did not examine infant outcomes, so it does not show that missed care harmed these infants. Data were collected during the COVID-19 pandemic, which may have affected workload and care routines even after adjustment for community severity.
Declared interests
The authors declared no conflicts of interest. The study was funded by the National Institute of Child Health and Human Development.
The easy way to misread this
Do not read this as proof that substance withdrawal caused missed nursing care or that the infants were harmed. It is an observational association based on nurse reports, and it did not test whether fixing staffing or workflow would reduce missed care.