Neonatal Abstinence Syndrome

Abstract

Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

Treating Neonatal Abstinence Syndrome from Clinical Perspectives

“…However in some other studies up to 90% of the neonates were reported to require pharmacologic treatment for NAS (7,20). The treatment rate varies depending on the type of drugs abused by mothers; the requirement for pharmacologic treatment is usually higher among poly substance and opioid exposed neonates while it is lower in stimulants only exposed neonates whose the majority do not require pharmacologic treatment (7,18).…”

“…Based on a recent report of national survey on drug use and health (NSDUH) in the United States 5.9% of pregnant women are using illicit drugs during gestation (6). Among the neonates who were exposed to illicit drugs in utero, withdrawal signs and symptoms requiring medical intervention develop in 27% -91% (7).…”

Implementation of a Neonatal Abstinence Syndrome Weaning Protocol: A Multicenter Cohort Study

“…2,6 Increases in the incidence of NAS have been reported uniformly in community hospitals, teaching hospitals, and children's hospitals, have affected all racial and ethnic groups, and have been described both nationally and internationally. [7][8][9][10] Variations in NAS treatment and associated outcomes persist in the absence of a nationally accepted, evidencebased, and generalizable treatment protocol. [11][12][13] The average length of hospitalization among infants treated for NAS is ∼16 days (23 days for infants receiving pharmacologic treatment of NAS), although longer stays are common.…”

Magnitude of Substance Use and Associated Factors among Pregnant Women Attending Jimma Town Public Health Facilities, Jimma Zone, Oromia Regional State Southwest Ethiopia

“…Substance use during pregnancy can affect the foetus both directly passing through placental barrier and indirectly through poor maternal health habits and environmental conditions [3,4].…”