Implicit Racial Bias in Evaluation of Neonatal Opioid Withdrawal Syndrome

Katherine Nyman; Francesca Okolie; Natalie L Davis; Erin Hager; Dina El-Metwally

doi:10.1007/s40615-023-01887-w

Implicit Racial Bias in Evaluation of Neonatal Opioid Withdrawal Syndrome

J Racial Ethn Health Disparities. 2023 Dec 18. doi: 10.1007/s40615-023-01887-w. Online ahead of print.

Authors

Katherine Nyman^{1

2}, Francesca Okolie^{3

4}, Natalie L Davis^{3

4}, Erin Hager⁵, Dina El-Metwally^{6

7}

Affiliations

¹ University of California San Diego School of Medicine, San Diego, CA, USA.
² Division of Neonatology, Rady Children's Hospital, San Diego, CA, USA.
³ University of Maryland Medical Center, Baltimore, MD, USA.
⁴ Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA.
⁵ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ University of Maryland Medical Center, Baltimore, MD, USA. dmetwally@som.umaryland.edu.
⁷ Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA. dmetwally@som.umaryland.edu.

PMID: 38110799
DOI: 10.1007/s40615-023-01887-w

Abstract

Objective: To assess implicit bias by administrating the Modified Finnegan Score (MFS) for quantifying neonatal opioid withdrawal and to evaluate risk of decreased opioid treatment of Black versus White infants.

Study design: Study participants were nurses recruited from a large tertiary care center who received three clinical vignettes portraying withdrawing infants and were randomized to receive an accompanying photo of either a Black or White infant. MFS results were compared for identical vignettes based on race of infant photo.

Results: Out of 275 nurses, 70 completed the survey. In vignette 2, nurses aged ≤35 years scored Black infants lower than White infants (MFS=8.3 ± 2 vs. 9.5 ± 1.2, p=0.012). Nurses with <5 years of experience and ≤10 years of experience also scored Black infants lower for the same vignette (8.2 ± 2.3 vs. 9.6 ± 1.2, p=0.032 and 8.3 ± 2 vs. 9.5 ± 1.2, p=0.0083).

Conclusion: Implicit bias may contribute to the difference in opioid treatment.

Keywords: Implicit bias; Neonatal opioid withdrawal syndrome; Neonate.