PROJECT SUMMARY/ABSTRACT This is an administrative supplement to our existing NIDA-funded grant entitled ?Clinical markers of neonatal opioid withdrawal syndrome: onset, severity and longitudinal neurodevelopmental outcome? (R01DA049755). Every 15 minutes in the United States, an infant is born exposed to opioids, many of which develop the difficult to treat drug withdrawal syndrome, Neonatal Opioid Withdrawal Syndrome (NOWS). Unfortunately, the diagnosis of NOWS is highly subjective and includes ?high pitched cry? simply based on the nurse?s judgement. The objective measurement of the acoustic characteristics of the cry in babies with NOWS is a pivotal component of the Specific Aims of the active award for this Administrative Supplement entitled ?Clinical markers of neonatal opioid withdrawal syndrome: onset, severity and longitudinal neurodevelopmental outcome? (R01DA049755): Aim 1: Determine neurobehavioral, cry, prenatal opioid and other substance exposure measured via maternal hair, and sociodemographic predictors of NOWS onset and severity. Aim 2: Evaluate the predictive validity of these clinical markers and test whether NOWS severity predicts neurodevelopment impairment at 6 and 18 months. We developed a computer-based cry analyzer that extracts the acoustic features of an infant?s cry. We used the cry analyzer to determine the acoustic characteristics of the cries of babies with NOWS and developed a NOWS cry ?signature? that can identify which babies develop NOWS with a 91% accuracy rate. However, the cry technology that we developed is not usable at the bedside. The Specific Aim of this Administrative Supplement Is to develop a cloud-based system for the automated analysis of infant cry acoustical characteristics for the diagnosis of NOWS. The proposed software will enable us to have a fully automatic system, where a user records a baby cry in the newborn nursery using a phone or other connected device, and within a few seconds, receives the diagnostic result. This Administrative Supplement will provide the cloud-based software to change clinical practice by providing a more accurate and reliable diagnosis of NOWS which will affect the pharmacological treatment of NOWS including length of hospital stay and potentially improve the long-term outcome of these infants.