Statewide Practice Survey of Assessment Tools Utilized for Opioid Withdrawal in Preterm and Critically Ill Newborns

We aimed to conduct a survey of assessment tools and provider satisfaction for neonatal opioid withdrawal syndrome (NOWS) in infants with preterm (<34 weeks gestational age [GA]) in-utero opioid exposure, or iatrogenic opioid exposure due to postnatal opioid exposure for neonatal critical illness in Massachusetts hospitals to characterize current practice.

A practice survey was sent to all birthing hospitals across Massachusetts in 2025 about scoring tools utilized for the assessment of NOWS in infants with in-utero opioid exposure who were preterm and those with iatrogenic withdrawal from opioids given to infants of any GA in the NICU for critical illness. The iatrogenic withdrawal questions were further broken down into full-term (>36 weeks GA) versus preterm (<34 weeks GA). Descriptive statistics were performed to summarize survey results.

Survey responses were received from 33 (84.6%) of 39 hospitals, with 25 hospitals included in the analysis which cared for the target population. The Eat, Sleep, Console NOWS tool was the most utilized across all populations (64% full-term in-utero, 48% pre-term in-utero, 40% iatrogenic), followed by the Finnegan and WAT-1 scales. Hospitals were more likely to have no formal tool for infants who were pre-term or with iatrogenic opioid exposure (24% pre-term in-utero, 20% iatrogenic, 0% full-term in-utero). When asked whether they felt current tools accurately captured opioid withdrawal in these populations, most providers felt unsure (48% pre-term in-utero, 52% iatrogenic) or that they were inaccurate (32% pre-term in-utero, 20% pre-term iatrogenic, 8% full-term iatrogenic). A vast majority of providers (96%) expressed interest in a tailored assessment tool for pre-term and critically ill infants.

There is no standardized approach, and there are wide variations in practices for assessing opioid withdrawal in pre-term and critically ill infants. A tailored assessment tool could lead to more accurate assessments and improve outcomes for these patients.

· There is no standard of care for NOWS assessments in preterm infants.. · There is no standard of care for opioid withdrawal assessments in critically ill infants.. · Wide variations in practice exist within NICUs for these infants with NOWS.. · There is a need for a validated assessment approach for this population..