Establishing Risk in Neonatal Abstinence Syndrome

The use of opioids and other psychoactive drugs during pregnancy is a major public health problem. Neonatal abstinence syndrome (NAS) affects up to 80% of infants exposed to opioids in utero, although its expression is highly variable. The current approach is to treat all opioid exposed infants as being at risk for NAS, using standard assessment tools followed by treatment when needed. These tools are 40 years old, highly subjective, and associated with significant inter-observer variability. “Low risk infants” remain in the hospital too long while “high risk infants” have delays in starting treatment. Since genetic factors appear to be important in NAS, it would be highly significant if clinical, demographic and genetic factors could be combined to more rapidly identify infants at risk of developing NAS. It is also essential to develop a better assessment tool for NAS. Our overarching hypothesis is that opioid-exposed infants will have better outcomes when we employ: 1) a prediction instrument using clinical, demographic, and genetic factors; 2) a simplified scoring system for the evaluation and treatment of NAS. Aim 1 will analyze clinical, demographic (n=1000) and genetic (n=680) data from mother-infant dyads enrolled in ongoing NAS studies. Aim 2 will then develop comprehensive risk assessment models to predict the development/severity of NAS and guide earlier prenatal/postnatal treatment. For Aim 3, we have already analyzed over 40,000 NAS scores and developed a shortened and more representative assessment tool. We will now validate this approach in a separate NAS cohort. Our long term goals are the development of a prediction tool to establish risk of significant NAS and a better assessment tool to guide earlier identification and treatment. While some candidate variables are already known, others require confirmation or remain to be discovered. These studies should enhance our understanding of NAS and significantly improve outcome.