Maternal and Infant Opioid Screening for Neonates at Risk

Identifying neonates at risk for neonatal opioid withdrawal syndrome (NOWS) is important to ensure adequate monitoring and treatment. We sought to evaluate 3 screening modalities-maternal history and physical (H&P), maternal urine drug screening (MUDS), and neonatal urine drug screening (NUDS)-in the identification of neonates at risk for NOWS.

Retrospective chart review was conducted for neonates with documented neonatal Finnegan scores at the University of Maryland Medical Center in Baltimore, Maryland, from January 1, 2017, through January 1, 2022. Maternal H&P was reviewed in addition to MUDS and NUDS. The institution's criterion for pharmacologic intervention is 2 or more consecutive Finnegan scores of 9 or greater. Treatment receipt was defined as documentation of morphine administration for treatment of withdrawal.

Of the 460 neonates included, most (452 (98.3%) were identified by maternal screening, which included a documented maternal history of opioid use or a positive MUDS result. No neonates received monitoring for NOWS based solely on NUDS. Maternal history of opioid use also had the highest sensitivity for identifying neonates who received treatment for NOWS (96.1%).

Maternal screening modalities including history and urine toxicology identify almost all neonates who require monitoring for NOWS. NUDS did not identify additional at-risk neonates. Prospective studies are warranted to assess a balanced approach to NUDS that prioritizes newborn safety while reducing maternal stigmatization and minimizing separation.