TY - JOUR
T1 - Standardizing the Clinical Definition of Opioid Withdrawal in the Neonate
AU - Jilani, Shahla M.
AU - Jones, Hendree Evelyn
AU - Grossman, Matthew
AU - Jansson, Lauren M.
AU - Terplan, Mishka
AU - Faherty, Laura J.
AU - Khodyakov, Dmitry
AU - Patrick, Stephen W.
AU - Davis, Jonathan M.
N1 - Funding Information:
Supported by funding from the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS Contract HHSP233201500038I_75P00120F37023 ). The views expressed in this article are those of the authors and not necessarily those of the Department of Health and Human Services or its divisions. The authors declare no conflicts of interest.
Publisher Copyright:
© 2022
PY - 2022/4
Y1 - 2022/4
N2 - Objective: To standardize the clinical definition of opioid withdrawal in neonates to address challenges in clinical care, quality improvement, research, and public policy for this patient population. Study design: Between October and December 2020, we conducted 2 modified-Delphi panels using ExpertLens, a virtual platform for performing iterative expert engagement panels. Twenty clinical experts specializing in care for the substance-exposed mother–neonate dyad explored the necessity of key evidence-based clinical elements in defining opioid withdrawal in the neonate leading to a diagnosis of neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS). Expert consensus was assessed using descriptive statistics, the RAND/UCLA Appropriateness Method, and thematic analysis of participants' comments. Results: Expert panels concluded the following were required for diagnosis: in utero exposure (known by history, not necessarily by toxicology testing) to opioids with or without the presence of other psychotropic substances, and the presence of at least two of the most common clinical signs characteristic of withdrawal (excessive crying, fragmented sleep, tremors, increased muscle tone, gastrointestinal dysfunction). Conclusions: Results indicate that both a known history of in utero opioid exposure and a distinct set of withdrawal signs are necessary to standardize a definition of neonatal withdrawal. Implementation of a standardized definition requires both patient engagement and a mother–neonate dyadic approach mindful of program and policy implications.
AB - Objective: To standardize the clinical definition of opioid withdrawal in neonates to address challenges in clinical care, quality improvement, research, and public policy for this patient population. Study design: Between October and December 2020, we conducted 2 modified-Delphi panels using ExpertLens, a virtual platform for performing iterative expert engagement panels. Twenty clinical experts specializing in care for the substance-exposed mother–neonate dyad explored the necessity of key evidence-based clinical elements in defining opioid withdrawal in the neonate leading to a diagnosis of neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS). Expert consensus was assessed using descriptive statistics, the RAND/UCLA Appropriateness Method, and thematic analysis of participants' comments. Results: Expert panels concluded the following were required for diagnosis: in utero exposure (known by history, not necessarily by toxicology testing) to opioids with or without the presence of other psychotropic substances, and the presence of at least two of the most common clinical signs characteristic of withdrawal (excessive crying, fragmented sleep, tremors, increased muscle tone, gastrointestinal dysfunction). Conclusions: Results indicate that both a known history of in utero opioid exposure and a distinct set of withdrawal signs are necessary to standardize a definition of neonatal withdrawal. Implementation of a standardized definition requires both patient engagement and a mother–neonate dyadic approach mindful of program and policy implications.
KW - neonatal abstinence syndrome
KW - neonatal opioid withdrawal syndrome
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U2 - 10.1016/j.jpeds.2021.12.021
DO - 10.1016/j.jpeds.2021.12.021
M3 - Article
C2 - 34942181
AN - SCOPUS:85123171845
SN - 0022-3476
VL - 243
SP - 33-39.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -