Neonatal Abstinence Syndrome Management From Prenatal Counseling to Postdischarge Follow-up Care: Results of a National Survey

Mehta, Aakriti; Forbes, Kathryn; Kuppala, Venkata Sasidhar

doi:10.1542/hpeds.2012-0079

Cited by 57 publications

(43 citation statements)

References 16 publications

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“…2,[8][9][10][11][12][13][14] Newborns with NAS are typically cared for in NICUs, where daily cost of care is high, and many of the preceding interventions are difficult to institute. 15,16 At project outset at our hospital, there was not a coordinated, standardized system that determined when, where, and how newborns with NAS would be cared for, and expectations for family participation in care were variable. The aim of this project was to improve the care of opioid-exposed newborns by involving families, standardizing assessment and treatment, and transitioning to rooming-in for the full hospital stay.…”

Section: Methodsmentioning

confidence: 99%

Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost

et al. 2016

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Section: Methodsmentioning

confidence: 99%

Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost

et al. 2016

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“…At present, the modified Finnegan scores remains the most common tool that is used. 126,127 The Finnegan scoring system is used for opioid and nonopioid withdrawal assessment. 70,96 Shortened or simplified versions of these scores have met with little success.…”

Section: Managementmentioning

confidence: 99%

“…127,145 Morphine decreases the incidence of seizures, improves feeding, eliminates diarrhea, decreases agitation, and can control severe symptoms. 146 However, morphine treatment also prolongs the length of hospital stay.…”

Section: Pharmacological Carementioning

confidence: 99%

“…161,162 Subsequent to these recommendations, some improvements in breastfeeding practices have been noted. 127,163 The amount of methadone or buprenorphine in breast milk is too small to treat NAS, and the sudden discontinuation of breast milk is not associated with the worsening of NAS 164,165 ; however, gradual weaning from breastfeeding is advised. 166 Because of the high concentrations of hydrocodone and oxycodone in breast milk as well as the reduced clearance of some of these medications in some neonates, mothers taking these prescription opioids should be alerted to the problem of sedation among infants when breastfeeding.…”

Section: Breastfeedingmentioning

confidence: 99%

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Neonatal Abstinence Syndrome

2014

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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.

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“…Although NICU settings provide the highest level acute care, they may separate the dyad which creates barriers to breastfeeding and rooming in both of which may decrease length of treatment and hospital stay for NAS (26, 27). Holmes et al demonstrated decreased hospital cost and length of stay for infants with NAS who experienced full rooming-in for observation and treatment on mother-infant pediatric units (25)**.…”

Section: Where To Treat Nasmentioning

confidence: 99%

Neonatal abstinence syndrome: an update

Sanlorenzo

Stark

Patrick

2018

Current Opinion in Pediatrics

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Purpose of review This review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to treat NAS, and the emerging role of quality improvement work in the field of NAS. Recent Findings The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms modified NAS expression and severity. Several centers have explored the use of new bedside assessments, focused on fewer factors to identify infants with NAS, that resulted in a decreased proportion of infants receiving pharmacotherapy for NAS. In addition, buprenorphine was shown to be a promising therapeutic alternative to morphine for treatment of NAS. Lastly, local, state and national quality improvement initiatives aimed to improve outcomes for infants with NAS emerged as an effective manner to advance the care of infants with NAS. Summary NAS remains a critical public health issue associated with significant medical, economic and personal burden. Emerging data on drivers of disease, assessment of withdrawal and treatment for NAS provide clinicians and hospitals with new knowledge and an urgency to promote standardization of care for infants with NAS.

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Neonatal Abstinence Syndrome Management From Prenatal Counseling to Postdischarge Follow-up Care: Results of a National Survey

Abstract: There is considerable diversity in the management of neonatal abstinence syndrome. Alternative management strategies, including prenatal counseling and home treatment programs, need to be explored to improve overall patient care.

Cited by 57 publications

References 16 publications

Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost

Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost

Neonatal Abstinence Syndrome

Neonatal abstinence syndrome: an update

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