Fetal gastric area ratio to predict severe neonatal opioid withdrawal syndrome

Neonatal opioid withdrawal syndrome (NOWS) can occur in newborns exposed to opioids in pregnancy. Opioids delay gastric emptying and inhibit gastric motility in adults, but little is known about their effect in the fetus. We sought to assess gastric area ratio (GAR) in opioid-exposed fetuses. Retrospective cohort study including opioid-exposed maternal-neonatal dyads between 2007–2017. Primary outcome: severe NOWS (three consecutive Finnegan scores ≥8 or three scores totaling ≥24 within 96 h of life). GAR: (gastric area)/(transverse abdominal area) × 100. Data analysis was by descriptive, parametric, and non-parametric tests. Forty-nine maternal-neonatal dyads were included, 67% (<i>n</i> = 33) with severe NOWS. GAR &lt;95th percentile for gestational age was seen in 80% of neonates (<i>n</i> = 39). However, GAR was not different between groups (<i>p</i> = .90) and did not predict severe NOWS. Fetal GAR was &lt;95th percentile in 80% of opioid-exposed neonates. However, fetal GAR may not predict NOWS treatment.