{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T09:38:09Z","timestamp":1792834689024,"version":"4.5.0"},"reference-count":15,"publisher":"American Academy of Pediatrics (AAP)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Xylazine is an \u03b12-adrenergic veterinary sedative increasingly detected as a fentanyl adulterant. Its impact on neonatal opioid withdrawal syndrome is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In this retrospective matched cohort study conducted at a level IV neonatal intensive care unit (NICU) between January 2023 and December 2025, infants with confirmed prenatal fentanyl and xylazine coexposure were matched 1 to 1 to fentanyl-only exposed infants on gestational age and sex. Exposure was confirmed by maternal or infant urine or meconium drug screens. Primary outcomes included nursery, NICU, total hospital length of stay (LOS), and rates of nasogastric (NG) tube placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Seventy xylazine-exposed infants were matched to 70 fentanyl-only controls. Groups were similar in birth weight, demographic characteristics, pharmacologic treatment rates, and peak eat, sleep, console scores. Xylazine-exposed infants had significantly longer median hospital LOS (21 vs 15.5\u00a0days, P\u2009&amp;lt;\u2009.01) and higher rates of NG tube placement (74 vs 53%, P\u2009=\u2009.01). Xylazine-exposed infants had greater polysubstance burden with a higher median number of coexposures (4 vs 2.5, P\u2009&amp;lt;\u2009.01) and were more likely to have cocaine (64 vs 33%, P\u2009&amp;lt;\u2009.01) and heroin (44 vs 17%, P\u2009&amp;lt;\u2009.01) coexposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Prenatal xylazine coexposure is associated with substantially greater clinical resource use compared with fentanyl exposure alone, including longer hospitalization and increased feeding support requirements, potentially reflecting xylazine\u2019s sedating and hypotonic effects on neonatal feeding behavior.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/hpeds.2025-009085","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:03:11Z","timestamp":1783468991000},"page":"e627-e631","source":"Crossref","is-referenced-by-count":0,"title":["Short-Term Outcomes of In-Utero Xylazine Exposure in Infants With NOWS"],"prefix":"10.1542","volume":"16","author":[{"given":"John","family":"Griffin","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Urschler","sequence":"additional","affiliation":[{"name":"2Division of Newborn Medicine, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Lopez","sequence":"additional","affiliation":[{"name":"3Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Riaz","sequence":"additional","affiliation":[{"name":"3Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Friedman","sequence":"additional","affiliation":[{"name":"2Division of Newborn Medicine, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary A.","family":"Vesoulis","sequence":"additional","affiliation":[{"name":"2Division of Newborn Medicine, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"5","key":"2026102404521428900_r1","doi-asserted-by":"crossref","first-page":"e2020029074","DOI":"10.1542\/peds.2020-029074","article-title":"Neonatal opioid withdrawal syndrome","volume":"146","author":"Patrick","year":"2020","journal-title":"Pediatrics."},{"issue":"2","key":"2026102404521428900_r2","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/ADM.0000000000000540","article-title":"Poverty and excess length of hospital stay in neonatal opioid withdrawal syndrome","volume":"14","author":"Vesoulis","year":"2020","journal-title":"J Addict Med."},{"issue":"3","key":"2026102404521428900_r3","doi-asserted-by":"crossref","DOI":"10.58616\/001c.122464","article-title":"Xylazine-induced skin necrosis, emerging public health crisis and the ethical considerations in surgical reconstruction: a case report","volume":"2","author":"Rose","year":"2024","journal-title":"SurgiColl."},{"issue":"8","key":"2026102404521428900_r4","first-page":"e66609","article-title":"Xylazine-induced necrotic skin ulcers in a fentanyl-injecting individual in South Florida, United States: a case report","volume":"16","author":"Cervantes","year":"2024","journal-title":"Cureus."},{"issue":"7","key":"2026102404521428900_r5","first-page":"e87545","article-title":"Xylazine withdrawal: a case report from the intensive care unit to the medical ward","volume":"17","author":"Yang","year":"2025","journal-title":"Cureus."},{"key":"2026102404521428900_r6","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ajem.2024.08.036","article-title":"Tranq dope: characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl\/xylazine","volume":"85","author":"London","year":"2024","journal-title":"Am J Emerg Med."},{"key":"2026102404521428900_r7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.forsciint.2014.03.015","article-title":"Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: a comprehensive review of the literature","volume":"240","author":"Ruiz-Col\u00f3n","year":"2014","journal-title":"Forensic Sci Int."},{"issue":"15","key":"2026102404521428900_r8","first-page":"7337","article-title":"Pharmacology and toxicology of xylazine: quid novum?","volume":"27","author":"Malaca","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci."},{"key":"2026102404521428900_r9","doi-asserted-by":"crossref","first-page":"1437960","DOI":"10.3389\/fphar.2024.1437960","article-title":"Fatal hyperpyrexia caused by xylazine: a case report","volume":"15","author":"Dai","year":"2024","journal-title":"Front Pharmacol."},{"key":"2026102404521428900_r10","author":"US Drug Enforcement Administration","year":"2022"},{"issue":"2","key":"2026102404521428900_r11","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/ADM.0000000000001396","article-title":"Xylazine positivity in opioid-positive drug screens on an inpatient labor unit","volume":"19","author":"Trammel","year":"2025","journal-title":"J Addict Med."},{"issue":"2","key":"2026102404521428900_r12","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/jalm\/jfab157","article-title":"Development and implementation of one-step, broad-spectrum, high-sensitivity drug screening by tandem mass spectrometry in a pediatric population","volume":"7","author":"Tesfazghi","year":"2022","journal-title":"J Appl Lab Med."},{"issue":"5","key":"2026102404521428900_r13","doi-asserted-by":"crossref","first-page":"e2023065610","DOI":"10.1542\/peds.2023-065610","article-title":"Clonidine as monotherapy for neonatal opioid withdrawal syndrome: a randomized trial","volume":"154","author":"Bada","year":"2024","journal-title":"Pediatrics."},{"issue":"5","key":"2026102404521428900_r14","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/ADM.0000000000000955","article-title":"Management of xylazine withdrawal in a hospitalized patient: a case report","volume":"16","author":"Ehrman-Dupre","year":"2022","journal-title":"J Addict Med."},{"key":"2026102404521428900_r15","article-title":"Health alert: risks of xylazine use and withdrawal in people who use drugs in Philadelphia. March 16, 2022","author":"Bettigole"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/16\/8\/e627\/1943938\/hosppeds.2025009085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/16\/8\/e627\/1943938\/hosppeds.2025009085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T08:52:20Z","timestamp":1792831940000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/16\/8\/e627\/208206\/Short-Term-Outcomes-of-In-Utero-Xylazine-Exposure"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":15,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,7,8]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2025-009085","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]}}}