Neonatal Abstinence Syndrome: Prevention, Recognition, Treatment, and Follow-up

Neonatal abstinence syndrome (NAS), or neonatal opioid withdrawal syndrome (NOWS) results from acute discontinuation of transplacental opioid exposure following delivery in the setting of maternal opioid use. A rise in the incidence of NAS coincides with the nationwide opioid epidemic. Addressing NAS requires a team approach. First, all pregnant women should be screened for substance use using validated questionnaires. Mothers who screen positive for opioid abuse should be referred to a provider experienced in opioid maintenance therapy. In addition to medical treatment emphasizing stability rather than detoxification, mental and situational health should be addressed. Next, mothers with opioid dependence should be educated regarding NAS. Topics for education include increased length of hospital stay following delivery, neonatal withdrawal symptoms, importance of the mother-baby dyad to treatment, and criteria for pharmacologic intervention. Following delivery, at-risk infants should be evaluated with standardized assessment tool such as Finnegan scoring or the eat-sleep-console tool while simultaneously maximizing nonpharmacologic interventions. Breast-feeding is encouraged in the absence of ongoing illicit or polysubstance use or infectious concerns. Pharmacologic treatment options most commonly include morphine or methadone. Infants without symptoms should be monitored for four to seven days prior to discharge, dependent on type of opioid exposure. Finally, infants with NAS are at risk for long-term mental and physical health problems. Therefore, infants will benefit from connection prior to hospital discharge with a primary care provider as well as entities designed for early childhood intervention and developmental assistance. The importance of well-child exams should be stressed to the family.