Intervention description {11a}
breast milk
This will be a pragmatic, randomized, blinded trial of opioid weaning to determine whether more rapid weaning, compared to slow wean, will reduce the number of days of opioid treatment in infants receiving morphine or methadone as the primary treatment for NOWS. Figure Overview of study timing and interventionConsistent with the pragmatic design, hospitals will use their specific management practices for opioid treatment among NOWS infants after birth and prior to randomization and the start of opioid weaning. This may include the following management practices:Location of care of the infant (mother-baby unit, NICU, Pediatric floor etc.).Frequency of monitoring of vital signs and use of cardiopulmonary monitors.A non-pharmacological bundle to control NOWS signs. We will recommend a standardized bundle, but hospitals will be able to optimize it for their own use.Use of breast milk and breast feeding.Scoring assessments of NOWS signs.Scoring criteria to initiate opioid therapy.Choice of opioid (morphine or methadone) as the primary treatment and dosing to initiate pharmacological therapy.Initiation and adjustment of dosing of second-line and third-line drugs for NOWS signs (e.g., phenobarbital, clonidine) if NOWS signs are not adequately controlled with an opioid.Duration of stabilization whereby the clinical team controls NOWS signs before they initiate opioid weaning.