Maternal and Infant Opioid Screening for Neonates at Risk

Area of Science:

• Neonatal Abstinence Syndrome Research
• Clinical Screening Modalities
• Pharmacological Interventions in Neonates

Background:

• Accurate identification of neonates at risk for neonatal opioid withdrawal syndrome (NOWS) is crucial for timely monitoring and treatment.
• Evaluating the efficacy of different screening methods is essential for optimizing care pathways.

Purpose of the Study:

• To compare the effectiveness of maternal history and physical (H&P), maternal urine drug screening (MUDS), and neonatal urine drug screening (NUDS) in identifying neonates at risk for NOWS.
• To assess the diagnostic performance of each screening modality in relation to treatment initiation for NOWS.

Main Methods:

• Retrospective chart review of 460 neonates with documented Finnegan scores at a tertiary medical center.
• Analysis of maternal H&P, MUDS, and NUDS data.
• Comparison of screening results with the institutional criterion for pharmacologic intervention (2+ consecutive Finnegan scores ≥9) and treatment receipt (morphine administration).

Main Results:

• Maternal screening (history or MUDS) identified 98.3% of neonates requiring NOWS monitoring.
• Neonatal urine drug screening (NUDS) alone did not identify any neonates for monitoring.
• Maternal history of opioid use demonstrated the highest sensitivity (96.1%) for identifying neonates who received NOWS treatment.

Conclusions:

• Maternal screening methods are highly effective in identifying neonates needing NOWS monitoring.
• NUDS did not add value in identifying additional at-risk neonates in this cohort.
• Further research is needed to balance newborn safety with reduced maternal stigma and separation in NUDS protocols.