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A Core Outcome Set for Neonatal Opioid Withdrawal Syndrome

Kelly, Lauren E.; Shan, Flora; MacVicar, Sonya; Czaplinksi, Emily; Moulsdale, Wendy; Simpson, Sarah; Allegaert, Karel; Jansson, Lauren M.; Offringa, Martin


Lauren E. Kelly

Flora Shan

Emily Czaplinksi

Wendy Moulsdale

Sarah Simpson

Karel Allegaert

Lauren M. Jansson

Martin Offringa


BACKGROUND: As rates of neonatal opioid withdrawal are increasing, the need for research to evaluate new treatments is growing. Large heterogeneity exists in health outcomes reported in current literature. Our objective is to develop an evidence-informed and consensus-based core outcome set in neonatal opioid withdrawal syndrome (NOWS-COS) for use in studies and clinical practice.

METHODS: An international multidisciplinary steering committee was established. A systematic review and a 3-round Delphi was performed with open-ended and score-based assessments of the importance of each outcome to inform clinical management of neonatal opioid withdrawal. Interviews were conducted with parents and/or caregivers on outcome importance. Finally, a consensus meeting with diverse stakeholders was held to review all data from all sources and establish a core set of outcomes with definitions.

RESULTS: The NOWS-COS was informed by 47 published studies, 41 Delphi participants, and 6 parent interviews. There were 63 outcomes evaluated. Final core outcomes include (1) pharmacologic treatment, (2) total dose of opioid treatment, (3) duration of treatment, (4) adjuvant therapy, (5) feeding difficulties, (6) consolability, (7) time to adequate symptom control, (8) parent-infant bonding, (9) duration of time the neonate spent in the hospital, (10) breastfeeding, (11) weight gain at hospital discharge, (12) readmission to hospital for withdrawal, and (13) neurodevelopment.

CONCLUSIONS: We developed an evidence-informed and consensus-based core outcome set. Implementation of this core outcome set will reduce heterogeneity between studies and facilitate evidence-based decision-making. Future research will disseminate all the findings and pilot test the validity of the NOWS-COS in additional countries and populations to increase generalizability and impact.


Kelly, L. E., Shan, F., MacVicar, S., Czaplinksi, E., Moulsdale, W., Simpson, S., …Offringa, M. (2020). A Core Outcome Set for Neonatal Opioid Withdrawal Syndrome. Pediatrics, 146(1),

Journal Article Type Article
Acceptance Date Apr 14, 2020
Online Publication Date Jul 1, 2020
Publication Date 2020-07
Deposit Date May 6, 2020
Journal Pediatrics
Print ISSN 0031-4005
Publisher American Academy of Pediatrics
Peer Reviewed Peer Reviewed
Volume 146
Issue 1
Article Number e20200018
Public URL

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