Written by Kimiko Dunbar
Spoon Feed
The development of severe neonatal opiate withdrawal s yndrome (NOWS) can be predicted with models that are more accurate than a history of opiate exposure alone.
Is eat, sleep, console sufficient?
The AAP recommends up to 7 days of observation of infants exposed to opioids to monitor for the development of NOWS. It’s difficult to predict which infants will be affected, and with what severity, resulting in unnecessary prolongation of hospitalization for some infants. This study aimed to adapt and validate a risk prediction model to identify neonates at birth who are at risk of developing severe NOWS, defined as the need for oral morphine. A prognostic study utilizing electronic health record data from 33,991 births applied logistic regression with a least absolute shrinkage and selection operator (LASSO) approach to identify key predictors. The model showed high discriminative ability (AUC 0.959; 95%CI 0.940–0.976). Opioid use disorder (aOR 47.0; 95%CI 26.7–82.7), maternal smoking (aOR 2.8; 95%CI 1.8–4.6), and a low 5-minute Apgar score were strong predictors. Decision curve analysis demonstrated greater clinical benefit than standard guideline criteria. The study was conducted at a single institution, limiting generalizability.
How does this change my practice?
This tool has exciting potential, although it needs to be validated for real-world applicability. While I’ve previously considered the specific details related to opiate use history when postulating about potential severity of NOWS, I hadn’t considered maternal smoking or low Apgar to be of particular relevance. I’ll certainly be looking out for these factors, although I don’t think this scoring system changes practice yet.
Source
Adapting a Risk Prediction Tool for Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2025 Apr 1;155(4):e2024068673. doi: 10.1542/peds.2024-068673. PMID: 40024274
