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Neonatal abstinence syndrome: essentials for the practitioner.

Anita Siu1, Christine A Robinson2

  • 1Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey ; Jersey Shore University Medical Center, Neptune, New Jersey.

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Summary

Neonatal Abstinence Syndrome (NAS) is rising due to maternal opiate use. Current treatments involve opioid replacement, with clonidine showing promise as an adjunctive therapy for infants.

Keywords:
abstinence syndromebuprenorphineclonidinemethadonemorphine

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Area of Science:

  • Neonatal care
  • Pharmacology
  • Public health

Background:

  • The incidence of Neonatal Abstinence Syndrome (NAS) has significantly increased over the last 15 years.
  • This rise is primarily attributed to increased antepartum maternal opiate use.
  • Optimal management strategies for NAS remain controversial due to limitations in existing research.

Purpose of the Study:

  • To review current treatment options for Neonatal Abstinence Syndrome (NAS).
  • To evaluate the efficacy of different pharmacologic interventions for NAS.
  • To identify areas for future research in NAS management.

Main Methods:

  • Review of published literature on Neonatal Abstinence Syndrome (NAS) treatment.
  • Analysis of primary treatment options: opioid replacement therapy (morphine, methadone).
  • Evaluation of adjunctive therapies, including phenobarbital and clonidine.

Main Results:

  • Opioid replacement therapy with morphine or methadone is the primary treatment for NAS.
  • Paregoric and tincture of opium are no longer recommended due to safety concerns.
  • Buprenorphine shows promise as an emerging treatment option.
  • Clonidine appears beneficial as an adjunctive therapy for infants not responding to monotherapy.

Conclusions:

  • Current NAS management relies on opioid replacement, with emerging options like buprenorphine.
  • Adjunctive therapies, particularly clonidine, may improve outcomes for difficult-to-treat cases.
  • Further research is needed, including comparative trials and exploring pharmacogenomics for optimized NAS management.