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Updated: Jun 20, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Therapeutic Update in Neonatal Opioid Withdrawal Syndrome: Comparative Effectiveness of Pharmacological Treatments

José Miguel Pérez-Jiménez1,2,3,4, Marta Periañez Langa2, Manuel Coheña Jimenez1,5

  • 1Institute of Biomedicine of Seville (IBiS) Seville Spain.

Health Science Reports
|April 20, 2026
PubMed

Insights

Neonatal opioid withdrawal syndrome (NOWS) management requires updated therapeutic approaches. Clonidine and buprenorphine are safer alternatives to morphine, and nursing-led care improves outcomes for infants and mothers.

Area of Science:

  • Neonatal care
  • Pharmacology
  • Evidence-based practice

Background:

  • Neonatal opioid withdrawal syndrome (NOWS) is increasing due to maternal opioid use.
  • Current therapeutic strategies for NOWS lack precise definition, impacting infant and maternal health.
  • There is a critical need to update clinical and therapeutic approaches for NOWS.

Purpose of the Study:

  • To update the therapeutic approach for neonates with NOWS.
  • To clarify the role of nursing in managing NOWS.
  • To provide evidence-based recommendations for opioid-exposed newborns.

Main Methods:

  • Systematic review conducted following PRISMA guidelines and the Cochrane Handbook.
  • Searched Scopus, Dialnet, Cinahl, and PubMed databases.
  • Included studies focused on therapeutic updates and nursing roles in NOWS; excluded case studies, non-opioid substances, and guidelines.

Main Results:

  • Analysis of 28 publications highlighted the need for updated diagnostic scales and treatments for NOWS.
  • Clonidine and buprenorphine showed better safety and shorter treatment durations than morphine for NOWS symptoms.
  • The ESC model with non-pharmacological interventions outperformed traditional Finnegan scoring.

Conclusions:

  • Clonidine and buprenorphine offer improved safety and efficacy over morphine in NOWS management.
  • The ESC model and non-pharmacological interventions significantly reduce pharmacotherapy, hospital stay, and costs.
  • Nursing-led holistic care is crucial for comprehensive NOWS management, enhancing breastfeeding and parental involvement.

Keywords:
breast feedingbuprenorphineclonidinemorphineneonatal abstinence syndromepatient care planning

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