Key PointsQuestionIs nonmethadone opioid treatment after surgical procedures associated with methadone use in infants with surgically treated necrotizing enterocolitis?FindingsIn this cohort study of 2037 infants with surgical necrotizing enterocolitis, 11% of infants required methadone treatment after surgical procedures, with overall use significantly varying by hospital. As the cumulative days an infant received nonmethadone opioids increased, the likelihood of methadone treatment increased.MeaningBy identifying infants with surgical necrotizing enterocolitis at the highest risk of methadone use, these findings suggest an opportunity to expand neonatal opioid stewardship efforts to improve patient outcomes and health care use.