Adapting a Risk Prediction Tool for Neonatal Opioid Withdrawal Syndrome

• DOI: 10.1542/peds.2024-068673
• Publication Date: 2025-03-03T00:02:56Z
• Authors: Thomas J. Reese; Andrew D. Wiese; Ashley A. Leech; Henry J. Domenico; Elizabeth A. McNeer; Sharon E. Davis; Michael E. Matheny; Adam Wright; Stephen W. Patrick
• Keywords: Guideline; Stepwise regression; Pharmacotherapy

BACKGROUND The American Academy of Pediatrics recommends up to 7 days observation for neonatal opioid withdrawal syndrome (NOWS) in infants with chronic exposure. However, many these will not develop NOWS, and seemingly less exposure opioids may severe NOWS that requires in-hospital pharmacotherapy. We adapted validated a prediction model help clinicians identify at birth who NOWS. METHODS This prognostic study included 33 991 births. Severe was defined as administration oral morphine. applied logistic regression least absolute shrinkage selection operator approach using 37 predictors. To contrast the guideline screening criteria, we conducted decision curve analysis mother receiving diagnosis use disorder (OUD) or prescription long-acting before delivery. RESULTS A total 108 were treated morphine 1243 had highly discriminative, an area under receiver operating 0.959 (95% CI, 0.940–0.976). strongest predictor mothers’ diagnoses OUD (adjusted odds ratio, 47.0; 95% 26.7–82.7). shows higher benefit across all levels risk, compared criteria. CONCLUSION Risk better support tailoring nonpharmacologic measures deciding whether extend hospitalization than alone.