Treatment of neonatal abstinence syndrome

Abstract

Neonatal abstinence syndrome (NAS) is suffered by infants withdrawing from substances on which they have become physically dependent after in utero exposure. They may require prolonged treatment and spend weeks or even months in hospital. A wide range of drugs have been used to treat NAS. The efficacy of few, however, have been adequately investigated. Evidence suggests that opioids are the most appropriate, at least in infants exposed to diamorphine or methadone. In all "head to head" trials, diazepam has been shown to be ineffective. Morphine and methadone are currently the most commonly prescribed opioids to treat NAS, but randomised trials have not been undertaken to determine which is the more beneficial. Many infants with NAS have been exposed to multiple substances in utero. Further research is required into whether a single opiate or a multiple drug regimen is the best option for such patients.

Neonatal abstinence syndrome—postnatal ward versus neonatal unit management

“…There was no statistically significant difference in the gestational age of the two groups we studied. The type of medication used can influence the duration of treatment for NAS, although there are few randomised studies [9]. Morphine has been demonstrated to be associated with a shorter duration of treatment than phenobarbitone [8] and more effective than the combination of phenobarbitone and diazepam [11].…”

Neonatal Drug Withdrawal

“…The abuse of multiple drugs during pregnancy is not uncommon, 79 but its effect on the occurrence and severity of neonatal abstinence is controversial. In 1 study, abstinence scores of infants whose mothers abused cocaine and methadone were similar to the scores of infants whose mothers received high-dose maintenance methadone.…”

Nursing infants with neonatal abstinence syndrome: Time to change practice?

“…In a recent study via postal questionnaire to all 245 neonatal units in the UK, with a 90 percent response rate, O'Grady et al (2009) reported that 23 different dosing regimens were in use, and less than half of the units were using the recommended morphine dosages as described in the British National Formulary for Children (BNFc). Similarly, in earlier studies, Johnson et al (2003) and Jackson et al (2004) reported that morphine dosages for the treatment of NAS were highly variable from unit to unit. These findings suggest that experts have yet to reach a treatment consensus, and that the development of a national guideline would be beneficial to aid the medical management of NAS.…”

“…Research into nursing care interventions in this condition are also lacking. Oei and Lui (2007), Johnson et al (2003) and Velez and Jansson (2008) each highlighted the need for randomised controlled trials of all aspects of the nonpharmacological care of infants with NAS, because the available evidence to support nursing care interventions is extremely limited. Shaw (1999) highlighted the need to simplify methods of assessing drug withdrawal in infants with NAS, yet years later, it remains evident there is a lack of significant development in this area.…”