Care of the Infant With Neonatal Abstinence Syndrome

Abstract

There is little empirical evidence that guides management of infants with neonatal abstinence syndrome. The standard of care first described in the 1970s is still prevalent today, although it has never been tested in this population. Standard of care interventions include decreasing external stimulation, holding, nonnutritive sucking, swaddling, pressure/rubbing, and rocking. These interventions meet the goals of nonpharmacologic interventions, which are to facilitate parental attachment and decrease external stimuli. Many nursing interventions used in infants with neonatal abstinence syndrome have been tested in low-birth-weight infants, whose treatment often includes the same goals. Those interventions include music therapy, kangaroo care, massage, and use of nonoscillating water beds. Nursing attitude has also been shown to be impactful on parental attachment. The American Academy of Pediatrics recommends breast-feeding in infants whose mothers are on methadone who do not have any other contraindication. It also provides guidelines for pharmacologic management but cannot provide specific recommendations about a standard first dose, escalation, or weaning schedule. Buprenorphine has some evidence about its safety in newborns with neonatal abstinence syndrome, but high-powered studies on its efficacy are currently lacking. There are many opportunities for both evidence-based projects and nursing research projects in this population.

Comparison of Time to First Dose of Oral Morphine in the Treatment of Neonatal Abstinence Syndrome

“…Therefore, some groups endorse translating results from studies of nonpharmacologic care in low birth weight infants to infants with NAS. 15 The results of international studies examining the treatment of infants with NAS in a rooming-in environment also support the use of nonpharmacologic interventions. [9][10][11] Allowing infants to remain in the hospital where they were born better facilitates parental involvement in their care, potentially leading to better outcomes and increased patient and parent satisfaction.…”

“…The goals of therapy for low birth weight infants and infants with NAS are similar including reducing environmental stimulation and promoting maternal‐infant bonding. Therefore, some groups endorse translating results from studies of nonpharmacologic care in low birth weight infants to infants with NAS . The results of international studies examining the treatment of infants with NAS in a rooming‐in environment also support the use of nonpharmacologic interventions .…”

Ohio Perinatal Quality Collaborative Improves Care of Neonatal Narcotic Abstinence Syndrome

“…supporting the nonpharmacologic bundles and institutional policies about the provision of breast milk in women exposed to opioids. 20 Roughly half the mothers of the infants with NAS were using illicit opioids, were not in a treatment program, and were determined to not be appropriate to breastfeed. Twenty-four percent of the infants were fed breast milk from their mothers, generally when they were in treatment programs.…”

“…The recommendation that infants with NAS receive care in low-stimulation environments is established practice; yet, it lacks systematic evaluation. 20 The inclusion of the mother as an active care partner was a significant shift for most hospitals. Many health care workers view families of infants with NAS through a judgmental lens, thinking, or even saying, "How could they do that to their baby?"…”

Management of Neonatal Abstinence Syndrome in the Newborn Nursery

“…Nonpharmacologic therapy has been introduced by experts in the field. While most are untested in the NAS infant population, they’re recognized as a standard of care (Maguire, ). These measures include quiet environment with low lighting and use of soft voices, clustering care and use of swaddling, pacifiers to promote “self‐soothing,” frequent, smaller feedings while allowing for sleep patterns to develop and vertical rocking during infant disorganization to decrease neurologic hyperactivity.…”