Effect of Neonatal Drug Screen on Monitoring and Management of Neonatal Opiate Withdrawal Syndrome [ID: 1376913

Abstract

INTRODUCTION: Neonates exposed to opiates in utero are at risk for developing neonatal opiate withdrawal syndrome (NOWS), which may require pharmacologic therapy if severe. Neonatal drug screening has been proposed to identify at-risk neonates that require extended monitoring for NOWS. We hypothesized that documented maternal history of opiate use would be prevalent and better predict the need for monitoring at our institution. METHODS: Retrospective chart review was conducted for 342 neonates with documented NOWS scores at the University of Maryland Medical Center in Baltimore, Maryland, from January 1, 2017 to January 1, 2022. Institutional review board approval was obtained prior to initiation of the study. Maternal medical history was reviewed in addition to neonatal drug screen, NOWS scores, and need for pharmacologic treatment. The primary objective was to determine the proportion of neonates for which neonatal drug screening was the only indicator that the neonate required monitoring for NOWS. RESULTS: There was a maternal indication for NOWS monitoring present at time of delivery for 85.4% of neonates. Of the remaining 50 (14.6%), 13 tested positive for opiates; however, only 3 of these neonates required pharmacologic treatment for NOWS. Seven neonates required treatment after negative opiate screening. Overall, the sensitivity of neonatal drug testing for NOWS requiring pharmacologic therapy was 76.3% with a positive predictive value of 55.8%. CONCLUSION: Maternal history of opiate use is present for most neonates monitored for NOWS, and neonatal drug screening incompletely predicted severe NOWS. Universal neonatal drug screening may not identify additional neonates at risk of NOWS with possible unforeseen risks including unnecessary monitoring or social services involvement.