Which newborns need monitoring for neonatal opioid withdrawal syndrome (NOWS)? Utilization and accuracy of methods to assess pregnancy opioid use

ABSTRACT

Background

A challenge in addressing neonatal opioid withdrawal syndrome (NOWS) is knowing who has been exposed and needs monitoring for withdrawal. Women do not always get asked about or disclose opioid use, and biologic testing is neither universal nor infallible. We investigate the prevalence and effectiveness of methods for identifying prenatal opioid exposure.

Methods

A review of medical charts at five delivery hospitals identified newborns with known exposure (i.e., NOWS diagnosis) for study inclusion.

Results

Over 95% of the mothers had 1+ urine drug screening (UDS) during pregnancy, 38% had UDS at delivery, 94% had documentation of self-report inquiry, and 81% of the newborns had biologic testing of meconium and/or cord tissue. Pregnancy UDS detected opioid use for 17% of the sample, UDS at delivery detected for 32%. A self-report of the use prenatally/at delivery identified 85%. Cord tissue testing was positive for 78%, meconium for 61%, and infant UDS 15%. 96% of the newborns were positive on 1+ exposure variable.

Conclusions

With drug testing only when indicated, almost all exposed pregnancies included inquiry about and biologic testing for opioid use/exposure. Reliance on any one assessment method may miss exposed newborns, but consideration of all information may identify most if not all newborns needing monitoring for NOWS.

KEYWORDS:

• Neonatal opioid withdrawal syndrome (NOWS)
• newborn drug exposure detection
• cord tissue testing

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported, in part, by a grant from the Johnson City, TN Junior League, and in- kind support from the East Tennessee State University Departments of Pediatrics and Family Medicine, the ETSU Addiction Science Center, and Ballad Health System Offices of Research and Information Technology.