An Amplitude-Integrated EEG Evaluation of Neonatal Opioid Withdrawal Syndrome

Christopher Lust, Zachary Vesoulis, John Zempel, Hongjie Gu, Stephanie Lee, Rakesh Rao, Amit M. Mathur

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective  Infants with neonatal opioid withdrawal syndrome (NOWS) have disrupted neurobehavior that requires hospitalization and treatment. This article aimed to evaluate electroencephalography (EEG) abnormalities using amplitude-integrated EEG (aEEG) in NOWS. Study Design  Eighteen term born infants with NOWS were recruited prospectively for an observational pilot study. aEEG monitoring was started within 24 hours of recruitment and twice weekly through discharge. aEEG data were analyzed for background and seizures. Severity of withdrawal was monitored using the modified Finnegan scoring (MFS) system. Results  Fifteen neonates had complete datasets. Thirteen (87%) had continuous aEEG background in all recordings. None had sleep-wake cyclicity (SWC) at initial recording. Brief seizures were noted in 9 of 15 (60%) infants. Lack of SWC was associated with higher MFS scores. At discharge, 8 of 15 (53%) had absent or emerging SWC. Conclusion  aEEG abnormalities (absent SWC) are frequent and persist despite treatment at the time of discharge in the majority of patients with NOWS. Brief electrographic seizures are common. Neonates with persistent aEEG abnormalities at discharge warrant close follow-up. Key Points EEG abnormalities are common and persist after clinical signs resolve in patients with NOWS. Short subclinical seizures may be seen. aEEG may identify neonates who need follow-up.

Original languageEnglish
JournalAmerican journal of perinatology
StateAccepted/In press - 2022


  • amplitude-integrated EEG
  • modified Finnegan score
  • neonatal opioid withdrawal syndrome
  • neonatal seizures
  • neonatal sleep-wake cyclicity


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