Advances in the Care of Infants With Prenatal Opioid Exposure and Neonatal Opioid Withdrawal Syndrome

Abstract

A significant number of advances have been made in the last 5 years with respect to the identification, diagnosis, assessment, and management of infants with prenatal opioid exposure and neonatal opioid withdrawal syndrome (NOWS) from birth to early childhood. The primary objective of this review is to summarize major advances that will inform the clinical management of opioid-exposed newborns and provide an overview of NOWS care to promote the implementation of best practices. First, advances with respect to standardizing the clinical diagnosis of NOWS will be reviewed. Second, the most commonly used assessment strategies are discussed, with a focus on presenting new quality improvement and clinical trial data surrounding the use of the new function-based assessment Eat, Sleep, and Console approach. Third, both nonpharmacologic and pharmacologic treatment modalities are reviewed, highlighting clinical trials that have compared the use of higher calorie and low lactose formula, vibrating crib mattresses, morphine compared with methadone, buprenorphine compared with morphine or methadone, the use of ondansetron as a medication to prevent the need for NOWS opioid pharmacologic treatment, and the introduction of symptom-triggered dosing compared with scheduled dosing. Fourth, maternal, infant, environmental, and genetic factors that have been found to be associated with NOWS severity are highlighted. Finally, emerging recommendations on postdelivery hospitalization follow-up and developmental surveillance are presented, along with highlighting ongoing and needed areas of research to promote infant and family well-being for families impacted by opioid use.

A Longitudinal Qualitative Study of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

“…Clearly outlined policies and procedures for the care of opioid-exposed dyads should drive the development of continuing education programs to guide nursing care that is supportive of breastfeeding goals. 30 While the focus of care for a neonate with NOWS is their health, neonatal nurses need to be aware that strengthening the caregiver's self-efficacy and self-esteem is critical to supporting successful breastfeeding, which will support the development of a healthy caregiver-newborn relationship. In turn, this relationship will facilitate optimal growth and development of an infant born to families coping with opioid use recovery.…”

“…The results confirm that the factors that disrupt the breastfeeding expectations of women on OMT can be addressed through better support from health care professionals and are not simply based on previous or current life experiences. Clearly outlined policies and procedures for the care of opioid-exposed dyads should drive the development of continuing education programs to guide nursing care that is supportive of breastfeeding goals 30. While the focus of care for a neonate with NOWS is their health, neonatal nurses need to be aware that strengthening the caregiver’s self-efficacy and self-esteem is critical to supporting successful breastfeeding, which will support the development of a healthy caregiver-newborn relationship.…”