Clinical and demographic predictors of the need for pharmacotherapy in neonatal abstinence syndrome

Abstract

Objective: Development and validation of a clinical prediction model for receipt of pharmacotherapy for Neonatal Abstinence Syndrome (NAS). Study design: Data from three cohorts included in- utero opioid exposed neonates ≥37 weeks gestation. Primary outcome was the receipt of pharmacotherapy utilizing a modified Finnegan Neonatal Abstinence Scoring System (FNASS). A stepwise multivariable logistic regression model was built and internally validated. Results: Of 698 infants included, 430 received pharmacotherapy. The final model included seven predictors of receipt of pharmacotherapy: gestational age, exposure to maternal breast milk, type of maternal opioid medication, and exposure to heroin, cocaine, benzodiazepines, and/or antipsychotic medications. The model had an AUROC of 0.68 (95% CI: 0.64–0.72; optimism corrected 0.65). Conclusion: Our prediction model was parsimonious and identified seven predictors associated with the need for PT. Larger cohort studies are needed to more definitively establish risk of significant NAS requiring pharmacotherapy.