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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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The Neonatal Withdrawal Assessment Tool (NWAT): pilot inter-rater reliability and content validity
Gonca Bektas1, Taylor Soderborg1, Cheryl Slater2
1Boston Combined Residency Program in Pediatrics, Boston Medical Center and Boston Children's Hospital, Boston, MA, USA.
Summary
A new tool, the Neonatal Withdrawal Assessment Tool (NWAT), shows high reliability for assessing opioid withdrawal in preterm infants. This pilot study suggests NWAT is a promising instrument for NICU clinical practice.
Area of Science:
- Neonatalogy
- Pharmacology
- Clinical Assessment Tools
Background:
- Iatrogenic opioid withdrawal is a significant concern in preterm infants within the Neonatal Intensive Care Unit (NICU).
- Currently, no validated tool exists to systematically assess this condition in this vulnerable population.
Purpose of the Study:
- To develop and pilot test the Neonatal Withdrawal Assessment Tool (NWAT) for assessing iatrogenic opioid withdrawal in preterm infants.
- To evaluate the inter-rater reliability (IRR) and content validity of the NWAT.
Main Methods:
- Fifty-one NICU providers assessed standardized simulated cases.
- Twenty paired provider assessments were conducted on five preterm infants.
- A survey was administered to providers to assess the content validity of the NWAT.
Main Results:
- The NWAT demonstrated high inter-rater reliability, with 95.6% agreement on simulated cases and 98.8% agreement on pilot infants.
- Provider surveys indicated strong agreement that the NWAT adequately measures withdrawal symptoms in critically ill infants.
- The tool showed high content validity in this pilot study.
Conclusions:
- The Neonatal Withdrawal Assessment Tool (NWAT) shows promising high inter-rater reliability and content validity for assessing iatrogenic opioid withdrawal in preterm infants.
- Further research with larger, diverse patient populations is recommended before widespread clinical adoption of the NWAT.
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