Neonatal abstinence syndrome: a case series from Colombo-Sri Lanka

Neonatal Abstinence Syndrome (NAS) is an escalating global health challenge driven by rising illicit drug use during pregnancy, a condition that remains underreported due to the non-specificity of symptoms and limited access to toxicological testing. This case series explores the clinical complexities and systemic hurdles in managing NAS within a resource-limited setting.

We reviewed 23 neonates clinically diagnosed with NAS at two level III neonatal care centres in Sri Lanka over 18 months. A majority of mothers were aged below 25 years (70%), 86.9% disclosed substance use upon admission for delivery, and all (100%) had poor antenatal care. Twenty-one out of 23 neonates were symptomatic and neurological manifestations, including irritability and tremors, were present in all symptomatic neonates. Management involved the Modified Finnegan Score to guide therapy, with 17 infants requiring pharmacological intervention, primarily oral morphine.

This case series reports the alarming fact of substance abuse among women under 25 years. It also highlights the challenges of management of neonatal abstinence syndrome, which imposes a profound strain on the healthcare system due to prolonged hospitalisations in high-cost tertiary units and the complex physiological demands of withdrawal including low birth weight and delayed weight gain.