Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel
Jul 23, 2021
The authors present the results of two modified-Delphi online expert panels consisting of national experts on substance-exposed mother-infant dyads. The goal of the study was to inform the work of a federal steering committee on the development of clinical definitions of neonatal abstinence syndrome and neonatal opioid withdrawal syndrome. Standardizing clinical definitions will help improve diagnosis, surveillance, and interventions.
From 2010 to 2017, the United States experienced a significant increase in maternal opioid-related diagnoses and neonatal abstinence syndrome (NAS). NAS is increasingly being referred to as neonatal opioid withdrawal syndrome (NOWS), as opioids are becoming the most common cause of neonatal withdrawal, whether alone or in the presence of other substances. A major challenge in the field is the lack of a standardized clinical definition of NAS.
To address this challenge, the authors convened two modified-Delphi expert panels consisting of national experts on substance-exposed mother-infant dyads. Through these online panels, the authors solicited expert opinion to inform the development of clinical definitions of NAS and NOWS for use at the bedside as part of the U.S. Department of Health and Human Services initiative on NAS. To convene the panels, the authors used ExpertLensTM, a previously evaluated platform for conducting iterative online modified-Delphi panels. Participants provided initial responses to study questions about key components of the clinical definition of NAS and NOWS; reviewed how their responses compared to those of other participants; and revised their responses based on group feedback and discussion, if needed.
Eighteen experts provided numeric ratings and free-text comments to contextualize their responses. Simple descriptive statistics, including frequency distributions, medians, interquartile ranges, as well as the RAND/UCLA Appropriateness Method Manual's approach to determining consensus in expert panels were used to analyze rating data, and the authors thematically analyzed the experts' free-text comments.
Clinical Signs of Withdrawal
In Utero Substance Exposures
Experts' Proposed Clinical Definitions of NAS and NOWS
Final Rating Results
Proposed Definitions of NAS and NOWS