Neonatal opioid withdrawal syndrome risk in newborns

Neonatal Opioid Withdrawal Syndrome (NOWS) comprises withdrawal symptoms resulting from prenatal exposure to opioids like morphine or methadone. Neonates born to parents who used opioids during pregnancy are at risk. The opioid epidemic in Canada has seen a threefold increase in the number of neonates at risk of NOWS between 2003 and 2014, with the highest incidences in Nova Scotia and New Brunswick. The United States exhibits a similar trend, with a fivefold increase in NOWS incidence from 2004 to 2014, primarily in rural areas. 

Despite this rising prevalence, neonates at risk of neonatal opioid withdrawal syndrome remain an inadequately researched group. NOWS symptoms vary but typically include central nervous system, metabolic, vasomotor, and respiratory disturbances, and gastrointestinal issues. Management mainly involves pharmacological treatment using titrated morphine. Nonpharmacological approaches are customised based on the neonate's specific symptoms, involving low-stimulation environments and soothing techniques. 

Neonates with NOWS experience longer hospital stays and are more likely to be admitted to the neonatal intensive care unit. They endure multiple painful procedures, which can lead to physiological instability and long-term adverse effects on neurocognitive development and pain sensitivity. 

Accurate pain assessment is crucial for effective pain management in neonates. Assessment measures consider contextual, behavioural, and physiological indicators. Composite biobehavioral pain assessment tools are commonly used but have limited research specific to neonates with NOWS. 

Existing research on pain assessments often excludes neonates at risk of NOWS due to the complexity of assessing pain in this population. Behavioural signs like crying and physiological changes may be indicators of withdrawal and pain. Therefore, a need exists for evidence synthesis of pain indicators and tools for neonates with different conditions, including those at risk of neonatal opioid withdrawal syndrome. 

A team has chosen a scoping review as a method to identify and analyse existing evidence on pain assessments in neonates at risk of NOWS. The review aims to pinpoint knowledge gaps and research opportunities to help with accurate pain assessment, crucial for the effective pain management in neonates. 

The scoping review protocol is available in the October issue of JBI Evidence Synthesis: 
Procedural pain assessment in neonates at risk of neonatal opioid withdrawal syndrome: a scoping review protocol 

Lavergne, Julianna; Langman, Erin; Mansell, Deborah; Dol, Justine; West, Claire; Benoit, Britney 

JBI Evidence Synthesis 21(10):p 2107-2114, October 2023. | DOI: 10.11124/JBIES-22-00414