Optimizing Pharmacologic Treatment for Neonatal Opioid Withdrawal Syndrome (OPTimize NOW): A Symptom-Based Dosing Approach (OPTimize NOW)

May 13, 2026 updated by: HELP for NOWS Consortium

This clinical trial will help us learn more about how to best care for babies with Neonatal Opioid Withdrawal Syndrome, also called NOWS. Babies with NOWS often have tremors, a hard time sleeping, excessive crying, and trouble feeding. Some babies that have NOWS need medicine. Doctors have two ways of providing medicine that are widely used today:

  1. Scheduled opioid taper approach. The baby gets medicine at regular times. As symptoms get better, the amount of medicine the baby gets decreases until the baby no longer needs medicine. This is called a medicine taper.
  2. Symptom-based approach. The baby will only get medicine when they show signs of NOWS, instead of at regular times. If the baby is showing no signs of NOWS, no medicine will be given.

We are doing the OPTimize NOW study to figure out the best way to give medicine to babies with NOWS.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This two-period cluster crossover clinical trial will compare the length of time from birth until medically ready for discharge between infants with neonatal opioid withdrawal syndrome (NOWS) who are ≥ 36 weeks' gestation, at risk for pharmacologic treatment, and treated for NOWS with either a symptom-based dosing approach or a scheduled opioid taper approach.

Each study site (i.e., cluster) will be randomized in a 1:1 allocation ratio to one of two sequences:

  • A three-week run-in period followed by a scheduled opioid taper approach for five months (Period 1) followed by a three-week washout period followed by a symptom-based dosing approach for five months (Period 2)
  • A three-week run-in period followed by a symptom-based dosing approach for five months (Period 1) followed by a three-week washout period followed by scheduled opioid taper approach for five months (Period 2)

The randomization scheme will be stratified by the assessment and management approach used at each study site (i.e., Finnegan or Eat, Seep and Console).

Study Type

Interventional

Enrollment (Actual)

626

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Alabama
      • Birmingham, Alabama, United States, 35294
        • University of Alabama at Birmingham
    • Arkansas
      • Little Rock, Arkansas, United States, 72205
        • University of Arkansas for Medical Sciences
    • Delaware
      • Wilmington, Delaware, United States, 19801
        • ChristianaCare
    • Florida
      • Tampa, Florida, United States, 33606
        • University of South Florida Health
    • Indiana
      • Indianapolis, Indiana, United States, 46202
        • Sidney & Lois Eskenazi Hospital
      • Jeffersonville, Indiana, United States, 47130
        • University of Louisville Hospital
    • Kansas
      • Kansas City, Kansas, United States, 66160
        • University of Kansas Hospital
    • Kentucky
      • Edgewood, Kentucky, United States, 41017
        • St. Elizabeth Healthcare
      • Lexington, Kentucky, United States, 40536
        • Kentucky Children's Hospital
      • Louisville, Kentucky, United States, 40202
        • Norton Children's Hospital
      • Louisville, Kentucky, United States, 40207
        • Norton Women's and Children's Hospital
    • Nebraska
      • Omaha, Nebraska, United States, 68198
        • University of Nebraska Medical Center
    • New Jersey
      • Atlantic City, New Jersey, United States, 08401
        • Atlanticare Regional Medical Center
    • New Mexico
      • Albuquerque, New Mexico, United States, 87131
        • University of New Mexico Health Sciences Center
    • New York
      • Rochester, New York, United States, 14642
        • University of Rochester Medical Center
    • Ohio
      • Cincinnati, Ohio, United States, 45229
        • Cincinnati Children's Hospital Medical Center
      • Cincinnati, Ohio, United States, 45202
        • Good Samaritan Hospital
      • Kettering, Ohio, United States, 45429
        • Kettering Health Main Campus
    • Oklahoma
      • Oklahoma City, Oklahoma, United States, 73104
        • Oklahoma Children's Hospital OU Health
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • Children's Hospital of Philadelphia
      • Philadelphia, Pennsylvania, United States, 19107
        • Thomas Jefferson University Hospital
      • Philadelphia, Pennsylvania, United States, 19107
        • Pennsylvania Hospital
    • Utah
      • Salt Lake City, Utah, United States, 84158
        • University of Utah Health

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. The infant is greater than or equal to 36 weeks gestation.

  2. The infant had antenatal opioid exposure identified by at least one of the following:

    • History of maternal opioid use during pregnancy;
    • Positive maternal toxicology screen for opioids during the second or third trimester of pregnancy; and/or
    • Positive infant toxicology screen for opioids during the initial hospital stay.
  3. The infant is being assessed and managed for NOWS at an eligible study site.

  4. The infant is at risk for pharmacologic treatment for NOWS defined by either of the following

    • At least 1 score ≥ 8 if assessed and managed with FNAST or modification thereof
    • At least 1 "yes" if assessed and managed with the ESC care approach

Exclusion Criteria:

  1. The infant has major birth defect(s).
  2. The infant has neonatal encephalopathy (inclusive of hypoxic ischemic encephalopathy), a metabolic disorder, stroke, intracranial hemorrhage, or meningitis diagnosed prior to the initiation of pharmacologic treatment.
  3. The infant is receiving respiratory support (any positive pressure or oxygen therapy) at 48 hours of age.
  4. The infant has undergone major surgical intervention prior to or at 48 hours of age.
  5. The infant has postnatal opioid exposure prior to the initiation of treatment for NOWS.
  6. The infant was outborn and pharmacologic treatment was initiated at the transferring hospital.
  7. The infant is assessed for eligibility during the study site's three-week washout period.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Sequence 1
This sequence will assign eligible participants to a three-week run-in period followed by a scheduled opioid taper approach for five months followed by a three-week washout period followed by symptom-based dosing approach for five months.
Other: Symptom-based Dosing Approach
During this approach to care, all enrolled infants with NOWS at the study site will be treated with the symptom-based dosing approach if they meet the withdrawal threshold for pharmacologic treatment. Participants may receive up to 3 doses of the study site's preferred opioid during a 24-hour period to treat signs of withdrawal once the threshold for pharmacologic intervention is met. If a 4th dose is required within a 24-hour period, the study site will transition to the scheduled opioid taper algorithm used at the study site to complete the infant's pharmacologic treatment.
Other: Scheduled Opioid Taper Approach
During this approach to care, all enrolled infants with NOWS at the study site will be treated with the study site's usual scheduled opioid taper approach, as detailed in each site's treatment algorithm, if they meet the withdrawal threshold for pharmacologic treatment.
Other: Sequence 2
This sequence will assign eligible participants to a three-week run-in period followed by a symptom-based dosing approach for five months followed by a three-week washout period followed by scheduled opioid taper approach for five months.
Other: Symptom-based Dosing Approach
During this approach to care, all enrolled infants with NOWS at the study site will be treated with the symptom-based dosing approach if they meet the withdrawal threshold for pharmacologic treatment. Participants may receive up to 3 doses of the study site's preferred opioid during a 24-hour period to treat signs of withdrawal once the threshold for pharmacologic intervention is met. If a 4th dose is required within a 24-hour period, the study site will transition to the scheduled opioid taper algorithm used at the study site to complete the infant's pharmacologic treatment.
Other: Scheduled Opioid Taper Approach
During this approach to care, all enrolled infants with NOWS at the study site will be treated with the study site's usual scheduled opioid taper approach, as detailed in each site's treatment algorithm, if they meet the withdrawal threshold for pharmacologic treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time from birth until medically ready for discharge (ESC cohort only)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.

Time from birth until infant meets criteria for medically ready for discharge (days). An infant is considered medically ready for discharge when they are discharged by the medical provider or when they meet the following criteria the following criteria:

  • ≥ 96 hours of age
  • ≥ 48 hours since last dose of opioid treatment (i.e., morphine, methadone, or buprenorphine)

This primary outcome is for infants assessed and managed using ESC.
From date of birth until hospital discharge or 1 year, whichever comes first.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time from birth until medically ready for discharge (Finnegan Cohort only)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.

Time from birth until infant meets criteria for medically ready for discharge (days). An infant is considered medically ready for discharge when they are discharged by the medical provider or when they meet the following criteria the following criteria:

  • 96 hours of age
  • 48 hours since last dose of opioid treatment (i.e., morphine, methadone, or buprenorphine)

This secondary outcome is for infants assessed and managed using Finnegan.
From date of birth until hospital discharge or 1 year, whichever comes first.
Receipt of pharmacologic treatment (ESC Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
If the infant received opioid replacement therapy prior to hospital discharge and was managed using ESC.
From date of birth until hospital discharge or 1 year, whichever comes first.
Length of hospital stay (ESC Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
Number of days infant remained in the hospital and managed with ESC.
From date of birth until hospital discharge or 1 year, whichever comes first.
Total number opioid doses (ESC Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of opioid doses administered among infants managed with ESC and pharmacologically treated during initial hospitalization.
From date of birth until hospital discharge or 1 year, whichever comes first.
Receipt of secondary medications (ESC Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of secondary opioid doses administered among infants managed with ESC and pharmacologically treated during initial hospitalization.
From date of birth until hospital discharge or 1 year, whichever comes first.
Transition from treatment with a symptom-based dosing approach to a scheduled opioid taper approach (ESC Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of infants managed with ESC and pharmacologically treated during initial hospitalization who transitioned from a symptom-based dosing approach to a scheduled opioid taper approach
From date of birth until hospital discharge or 1 year, whichever comes first.
Stopped scheduled opioid taper treatment (ESC Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of infants managed with ESC and pharmacologically treated during initial hospitalization who were initially treated with a scheduled opioid taper but stopped treatment due to excessive sedation or respiratory depression
From date of birth until hospital discharge or 1 year, whichever comes first.
Receipt of pharmacologic treatment (Finnegan Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
If the infant received opioid replacement therapy prior to hospital discharge and was managed using Finnegan.
From date of birth until hospital discharge or 1 year, whichever comes first.
Length of hospital stay (Finnegan Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
Number of days infant remained in the hospital and managed with Finnegan.
From date of birth until hospital discharge or 1 year, whichever comes first.
Total number opioid doses (Finnegan Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of opioid doses administered among infants managed with Finnegan and pharmacologically treated during initial hospitalization.
From date of birth until hospital discharge or 1 year, whichever comes first.
Receipt of secondary medications (Finnegan Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of secondary opioid doses administered among infants managed with Finnegan and pharmacologically treated during initial hospitalization.
From date of birth until hospital discharge or 1 year, whichever comes first.
Transition from treatment with a symptom-based dosing approach to a scheduled opioid taper approach (Finnegan Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of infants managed with Finnegan and pharmacologically treated during initial hospitalization who transitioned from a symptom-based dosing approach to a scheduled opioid taper approach
From date of birth until hospital discharge or 1 year, whichever comes first.
Stopped scheduled opioid taper treatment (Finnegan Cohort)
Time Frame: From date of birth until hospital discharge or 1 year, whichever comes first.
The total number of infants managed with Finnegan and pharmacologically treated during initial hospitalization who were initially treated with a scheduled opioid taper but stopped treatment due to excessive sedation or respiratory depression
From date of birth until hospital discharge or 1 year, whichever comes first.
Inpatient Composite Safety Outcome for infants at risk for pharmacologic treatment, managed with ESC (present/absent)
Time Frame: From date of birth until hospital discharge
A composite safety outcome for infants at risk for pharmacologic treatment, managed with ESC, defined as the occurrence of any of the following events between birth and hospital discharge: Seizures, Excessive weight loss >15% from birthweight
From date of birth until hospital discharge
Inpatient Composite Safety Outcome for infants at risk for pharmacologic treatment, managed with Finnegan (present/absent)
Time Frame: From birth until hospital discharge
A composite safety outcome for infants at risk for pharmacologic treatment, managed with Finnegan defined as the occurrence of any of the following events between birth and hospital discharge: Seizures, Excessive weight loss >15% from birthweight
From birth until hospital discharge
Inpatient Composite Critical Safety Outcome for infants at risk for pharmacologic treatment, managed with ESC (present/absent)
Time Frame: From birth until hospital discharge
A composite critical safety outcome for infants at risk for pharmacologic treatment, managed with ESC defined as the occurrence of any of the following events between birth and hospital discharge: Non accidental trauma, Death
From birth until hospital discharge
Inpatient Composite Critical Safety Outcome for infants at risk for pharmacologic treatment, managed with Finnegan (present/absent)
Time Frame: A composite critical safety outcome for infants at risk for pharmacologic treatment, managed with Finnegan defined as the occurrence of any of the following events between birth and hospital discharge: Non accidental trauma, Death
From birth until hospital discharge
A composite critical safety outcome for infants at risk for pharmacologic treatment, managed with Finnegan defined as the occurrence of any of the following events between birth and hospital discharge: Non accidental trauma, Death
Outpatient Composite Safety Outcome at risk for pharmacologic treatment, managed with ESC (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite outpatient safety outcome for infants at risk for pharmacologic treatment, managed with ESC defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Acute/urgent care or emergency room visits, Hospital readmissions
From hospital discharge to 3 months of age
Outpatient Composite Safety Outcome at risk for pharmacologic treatment, managed with Finnegan (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite outpatient safety outcome for infants at risk for pharmacologic treatment, managed with Finnegan defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Acute/urgent care or emergency room visits, Hospital readmissions
From hospital discharge to 3 months of age
Outpatient Composite Critical Safety Outcome at risk for pharmacologic treatment, managed with ESC (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite critical outpatient safety outcome for infants at risk for pharmacologic treatment, managed with ESC defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Non accidental trauma, Death
From hospital discharge to 3 months of age
Outpatient Composite Critical Safety Outcome at risk for pharmacologic treatment, managed with Finnegan (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite critical outpatient safety outcome for infants at risk for pharmacologic treatment, managed with Finnegan defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Non accidental trauma, Death
From hospital discharge to 3 months of age
Inpatient Composite Safety Outcome for infants treated pharmacologically, managed with ESC (present/absent)
Time Frame: From birth to hospital discharge
A composite safety outcome for infants treated pharmacologically, managed with ESC, defined as the occurrence of any of the following events between birth and hospital discharge: Seizures; Excessive weight loss >15% from birthweight
From birth to hospital discharge
Inpatient Composite Safety Outcome for infants treated pharmacologically, managed with Finnegan (present/absent)
Time Frame: From birth to hospital discharge
A composite safety outcome for infants treated pharmacologically, managed with Finnegan, defined as the occurrence of any of the following events between birth and hospital discharge: Seizures; Excessive weight loss >15% from birthweight.
From birth to hospital discharge
Inpatient Composite Critical Safety Outcome for infants treated pharmacologically, managed with ESC (present/absent)
Time Frame: From birth to hospital discharge
A composite critical safety outcome for infants treated pharmacologically, managed with ESC, defined as the occurrence of any of the following events between birth and hospital discharge: Non accidental trauma; Death.
From birth to hospital discharge
Inpatient Composite Critical Safety Outcome for infants treated pharmacologically, managed with Finnegan (present/absent)
Time Frame: From birth to hospital discharge
A composite critical safety outcome for infants treated pharmacologically, managed with Finnegan, defined as the occurrence of any of the following events between birth and hospital discharge: Non accidental trauma; Death.
From birth to hospital discharge
Outpatient Composite Safety Outcome for infants treated pharmacologically, managed with ESC (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite outpatient safety outcome for infants treated pharmacologically, managed with ESC, defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Acute/urgent care or emergency room visits; Hospital readmissions.
From hospital discharge to 3 months of age
Outpatient Composite Safety Outcome for infants treated pharmacologically, managed with Finnegan (present/absent
Time Frame: From hospital discharge to 3 months of age
A composite outpatient safety outcome for infants treated pharmacologically, managed with Finnegan, defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Acute/urgent care or emergency room visits; Hospital readmissions.
From hospital discharge to 3 months of age
Outpatient Composite Critical Safety Outcome for infants treated pharmacologically, managed with ESC (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite critical outpatient safety outcome for infants treated pharmacologically, managed with ESC, defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Non accidental trauma; Death.
From hospital discharge to 3 months of age
Outpatient Composite Critical Safety Outcome for infants treated pharmacologically, managed with Finnegan (present/absent)
Time Frame: From hospital discharge to 3 months of age
A composite critical outpatient safety outcome for infants treated pharmacologically, managed with Finnegan, defined as the occurrence of any of the following events between hospital discharge and 3 months of age: Non accidental trauma; Death.
From hospital discharge to 3 months of age

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

HELP for NOWS Consortium

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
National Institutes of Health (NIH)

Investigators

  • Principal Investigator: Lori Devlin, MD, University of Louisville

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 25, 2024

Primary Completion (Actual)

May 27, 2025

Study Completion (Actual)

July 15, 2025

Study Registration Dates

First Submitted

July 27, 2023

First Submitted That Met QC Criteria

July 27, 2023

First Posted (Actual)

August 7, 2023

Study Record Updates

Last Update Posted (Actual)

May 18, 2026

Last Update Submitted That Met QC Criteria

May 13, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HELP for NOWS 02
  • 1U24HD107621 (U.S. NIH Grant/Contract)
  • 1UG1HD107628 (U.S. NIH Grant/Contract)
  • 1UG1HD107580 (U.S. NIH Grant/Contract)
  • 1UG1HD107649 (U.S. NIH Grant/Contract)
  • 1UG1HD107650 (U.S. NIH Grant/Contract)
  • 1UG1HD107653 (U.S. NIH Grant/Contract)
  • 1UG1HD107627 (U.S. NIH Grant/Contract)
  • 1UG1HD107631 (U.S. NIH Grant/Contract)
  • 1UG1HD107616 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Data collected for this study will be analyzed and stored at the DCC, RTI International. NIH Helping to End Addiction Long-term Initiative (HEAL) and NICHD requirements for data-sharing will apply. NIH has had a long-standing policy to share and make available to the public the results and accomplishments of the activities that it funds. In accordance with these policies (available at HEAL Public Access and Data Sharing | NIH HEAL Initiative), we will share de-identified data collected for the study. After the study is completed, the de-identified, archived data will be transmitted to a NIH HEAL supported repository, for use by other researchers including those outside of the study.

IPD Sharing Time Frame

Within 1 year of study completion.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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