Neonatal Neurobehavior Predicts Neonatal Opioid Withdrawal Syndrome Severity Prior to Treatment Interventions

Objective To utilize the NeoNatal Neurobehavioral Scale (NNNS-II) as a standardized and reliable tool to help guide treatment of neonatal opioid withdrawal syndrome (NOWS) with the goal of improving the consistency and quality of care provided to opioid-exposed newborns. Study design We examined NOWS severity through several indicators, including the number of pharmacological treatment medications, maximum dose of medications, length of treatment, and maximum score on NOWS observational tools to create an overall severity score for each newborn. Then we examined whether NOWS risk could be detected as early as 24 hours after birth using the NNNS-II to predict NOWS severity. Results Newborn neurobehavior prior to signs of NOWS predicted NOWS severity. Newborns who were more hypertonic and had poorer quality of movement had higher severity scores. Conclusion These findings indicate that NOWS risk detection may be enhanced with an early newborn neurobehavioral assessment. (J Pediatr 2025;281:114533).