Standardizing the Clinical Definition of Opioid Withdrawal in the Neonate

Published in: The Journal of Pediatrics (2021). doi: 10.1016/j.jpeds.2021.12.021

Posted on RAND.org on January 04, 2022

by Shahla Jilani, Hendrée E. Jones, Matthew Grossman, Lauren M. Jansson, Mishka Terplan, Laura J. Faherty, Dmitry Khodyakov, Stephen W. Patrick, Jonathan M. Davis

Read More

Access further information on this document at Science Direct

This article was published outside of RAND. The full text of the article can be found at the link above.

Objective

To address challenges in clinical care, quality improvement, research, and public policy for prenatally opioid-exposed neonates by standardizing the clinical definition of opioid withdrawal.

Study Design

Between October and December 2020, we conducted two 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) 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/continuous 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/harmonize 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.

Access further information on this document at Science Direct

This article was published outside of RAND. The full text of the article can be found at the link above.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.