For a study, researchers sought to standardize the clinical diagnosis of opioid withdrawal in newborns in order to address issues in clinical treatment, quality improvement, research, and public policy for the patient population. They used ExpertLens, a virtual platform for doing iterative expert engagement panels, to conduct two modified-Delphi panels between October and December 2020. Twenty clinical experts specialized in substance-exposed mother–neonatal dyad care investigated the importance of crucial evidence-based clinical features in identifying opioid withdrawal in the neonate leading to a diagnosis of neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS). Descriptive statistics, the RAND/UCLA Appropriateness Method, and thematic analysis of participant comments were used to measure expert consensus. 

Expert panels agreed that the following criteria were required for diagnosis: in utero exposure to opioids (known through history, not necessarily through toxicology testing), with or without the presence of other psychotropic substances, and the presence of at least two of the most common clinical signs of withdrawal (excessive crying, fragmented sleep, tremors, increased muscle tone, gastrointestinal dysfunction).

The findings suggested that standardizing a definition of neonatal withdrawal required both a known history of in utero opioid exposure and a specific collection of withdrawal indicators. Implementing a uniform definition necessitated patient involvement as well as a mother–neonate dyadic approach that considered program and policy implications.