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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

Management of neonatal abstinence syndrome from opioids

Kendra Grim1, Tracy E Harrison, Robert T Wilder

  • 1Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55902, USA.

Clinics in Perinatology
|August 27, 2013
PubMed

Insights

Neonatal Abstinence Syndrome (NAS) often involves multiple drug exposures, complicating treatment. Current NAS evaluation scales focus on opioid withdrawal, and a standardized treatment protocol is lacking.

Area of Science:

  • Neonatal Abstinence Syndrome (NAS) research
  • Pharmacology in neonates
  • Pediatric drug evaluation

Background:

  • Most infants at risk for neonatal abstinence syndrome (NAS) experience exposure to opioids plus other substances, making polypharmacy common.
  • Existing scales for NAS evaluation primarily assess opioid withdrawal symptoms.
  • A universally accepted standard protocol for treating NAS has not yet been established.

Purpose of the Study:

  • To highlight the complexities of treating neonatal abstinence syndrome (NAS) due to polypharmacy.
  • To emphasize the need for standardized NAS treatment protocols.
  • To review current recommendations for NAS management.

Main Methods:

  • Review of existing literature and clinical guidelines on neonatal abstinence syndrome (NAS).
  • Analysis of current practices in NAS evaluation and treatment.
  • Examination of recommended therapeutic strategies for opioid withdrawal in neonates.

Main Results:

  • Polypharmacy (opioid plus another drug exposure) is prevalent in infants at risk for NAS.
  • Current NAS assessment tools are predominantly based on opioid withdrawal.
  • Nonpharmacologic strategies are recommended for all at-risk neonates.
  • The American Academy of Pediatrics endorses mechanism-directed therapy (opioid for opioid withdrawal) as first-line treatment.
  • Second-line medications for NAS are currently under investigation.

Conclusions:

  • Neonatal Abstinence Syndrome (NAS) management is complex due to frequent polypharmacy.
  • Standardized NAS treatment protocols are critically needed.
  • Nonpharmacologic interventions and mechanism-directed therapy are key components of current NAS management strategies.

Keywords:
AbstinenceBuprenorphineMethadoneNeonatalOpioidsWithdrawal

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