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Review
. 2019 Apr;24(2):133-141.
doi: 10.1016/j.siny.2019.01.009. Epub 2019 Feb 5.

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)

A K Mangat  1 , G M Schmölzer  2 , W K Kraft  3
Affiliations
Review

Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS)

A K Mangat et al. Semin Fetal Neonatal Med. 2019 Apr.

Abstract

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of >8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of initial manifestations, should be first be managed with non-pharmacologic approaches which in turn, should not be considered as the sole alternative to drug therapy, but rather, as the base upon which all patients are treated. Those who continue to have symptoms despite supportive care should be pharmacologically treated, which in the most severe cases, is life-saving.

Keywords: Infant; Neonatal abstience syndrome; Opioid.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1:
Figure 1:
Representative Modified Finnegan Score
Figure 2:
Figure 2:
Approach to infants with in utero opioid exposure. All infants should be provided a base of non-pharmacologic therapies. Specific measures will vary with the ability of the local site to provide. Some potential approaches are listed. Pharmacologic therapy is added only in those for whom symptoms are not controlled with non-pharmacologic means.
Figure 3:
Figure 3:
Role of Adjunctive Therapies. The optimal use of adjunctive therapy with an opioid has not been defined. (A) An adjunct is used only when symptoms are severe and the adjunct is weaned before the opioid. (B) The adjunct is started in those not controlled with an opioid, but the adjunct is continued after the opioid is weaned, sometimes in an outpatient setting. (C) The adjunct serves as an opioid sparing agent which is started and stopped at the same time as the opioid.
Figure 4:
Figure 4:
NAS Treatment Flowchart at the Royal Alexandra Hospital, Edmonton, Canada
See this image and copyright information in PMC

References

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