The Neonatal Withdrawal Assessment Tool (NWAT): Pilot inter-rater reliability and content validity

Abstract OBJECTIVE: There is no validated tool to assess withdrawal in preterm infants in the newborn intensive care unit (NICU) being weaned from pharmacological sedation. STUDY DESIGN: The Neonatal Withdrawal Assessment Tool (NWAT) was developed to address this gap in clinical practice. In this pilot study, the NWAT was assessed for inter-rater reliability (IRR) and content validity. RESULT: Fifty-one NICU providers scored two standardized simulated cases, then 20 paired provider assessments were completed on 5 preterm infants. The overall IRR was 95.6% on the simulated cases, and 98.8% on the 5 pilot infants. A provider survey assessed for content validity; more than 85% of provider participants strongly agreed/agreed that the NWAT adequately measures withdrawal in critically ill infants. CONCLUSION: The NWAT demonstrated high IRR and content validity for assessment of withdrawal in preterm infants. Further studies in a larger more diverse patient population are needed before wider adoption into clinical practice.