Neonatal Opioid Withdrawal Scoring

Neonatal opioid withdrawal syndrome (NOWS), historically called neonatal abstinence syndrome (NAS), is withdrawal after prenatal opioid exposure ends at birth. Loss of ongoing opioid effect produces dysregulation across neurologic, autonomic, respiratory, gastrointestinal, and musculoskeletal systems. The intensity and timing vary with the substance, exposure pattern, metabolism, co-exposures, and gestational age. The pattern is broader than tremor. Findings may include irritability, increased tone and Moro reflex, high-pitched or excessive crying, tremors, disturbed sleep, poor feeding coordination, regurgitation or diarrhea, sweating, sneezing, fever or temperature instability, tachypnea, respiratory distress, weight loss, lethargy, apnea, and seizures. A cluster across systems and impaired function is more meaningful than one isolated sign. An assessment tool describes withdrawal-related function or symptom burden; it does not establish the diagnosis by itself. Hypoglycemia, hypocalcemia, central nervous system injury, hyperthyroidism, sepsis and other infections can resemble NOWS. Interpret the exposure history, examination, feeding and sleep pattern, vital signs, hydration, weight trend, and response to supportive care together. An atypical or rapidly worsening course warrants immediate notification of the neonatal physician or nurse practitioner rather than an assumption that withdrawal...