Neonatal opioid withdrawal syndrome (NOWS) is a result of prenatal opioid exposure. There is currently no evidence regarding pain assessment in neonates at risk of NOWS. The scoping review was conducted using the JBI scoping review methodology. A total of 22,731 studies were screened, with five studies included.

Background & Aims: Neonatal opioid withdrawal syndrome (NOWS) occurs when a neonate is born to a birth parent who identified as having sustained opioid use (such as morphine, and/or heroin) during pregnancy. While pain indicators and composite pain scores are valid and reliable for healthy neonates, there is no review of evidence regarding pain assessment in neonates at risk of NOWS. The aim of this review was to identify evidence for pain assessment during acute procedures in hospitalized neonates at risk of NOWS. 

Methods: The scoping review was conducted using the JBI scoping review methodology (1,2,3). Databases searched included MEDLINE, CINAHL, Embase, PsycInfo, and Scopus. Eligible studies included those reporting on hospitalized preterm and full-term neonates at risk of NOWS having pain assessments (i.e., behavioral indicators, physiological indicators, validated composite pain scores) during and/or after exposure to an acute painful procedure. Relevant data were extracted by two reviewers using a modified JBI extraction tool. 

Results: A total of 22,731 unique studies were screened, with five studies included (4,5,6,7,8). Of these studies, two included neonates at risk of NOWS but did not report pain responses separately. The three remaining studies observed procedural pain in opioid-exposed neonates compared to neonates without opioid exposure during heel lance. Various pain assessment methods were reported on including physiologic responses (heart rate, respiratory rate, oxygen saturation, skin conductance, electroencephalogram) and validated composite pain scores (PIPP, NFCS, BPSN). When using composite pain tools, one study showed higher pain response in opioid-exposed neonates (8), while the other two studies showed the same or lower pain response (6,7). For skin conductance the findings from two studies were discrepant, with one study reporting higher pain response in opioid-exposed neonates (8) and the other showing no statistically significant difference (6).

Conclusion: There is a need for further observational studies designed to examine the influence of opioid exposure and withdrawal on pain responding and management in neonates. As there is currently limited evidence to guide clinical care, clinicians should continue to use composite pain assessment tools and pain management strategies established for healthy neonates.