Opioid Neonatal Abstinence Syndrome: Controversies and Implications for Practice

Abstract

The Opioid Neonatal Abstinence Syndrome (NAS) is a term used to describe a cluster of signs and symptoms seen in infants experiencing withdrawal from opioid drugs. Despite a substantial literature the relationship between maternal methadone dose, NAS and the method of assessment of NAS symptoms has not been agreed. The following review will address current and historical controversies surrounding these issues and will examine the evidence concerned with the evaluation of neonates exposed to methadone in utero. The key findings are as follows: A variety of NAS scales are used to assess the severity of neonatal withdrawal symptoms including locally adapted validated tools. Inconsistencies in the use of NAS scales have included the timing, duration and frequency of administration; the degree to which observers were trained to reliability; the use of NAS scales designed for term neonates to assess pre-term neonates who may have a qualitatively different expression of abstinence symptoms and; the research setting in which the tool was administered. There is a lack of research investigating the observant bias' effect upon scoring NAS, the basis for treatment decisions and the influence of concomitant maternal use of non-opioid drugs late in pregnancy. We also discuss the implications of the lack of recognition of NAS symptoms leading to possible under reporting and inappropriate, early neonatal discharge from hospital. In addition, this paper also discusses the merits and problems of conducting research in this area and highlights gaps in our knowledge and areas for further research.

Opioid and Benzodiazepine Weaning in Pediatric Patients: Review of Current Literature

“…Neonatal withdrawal was also excluded from this review, and therefore the FNAST or its use outside of the studies reviewed was not assessed. There are numerous studies on neonatal withdrawal and the FNAST that could and have been reviewed in previous literature . Finally, withdrawal was assessed but not reported in three studies and was not assessed at all in two studies.…”

“…There are numerous studies on neonatal withdrawal and the FNAST that could and have been reviewed in previous literature. [41][42][43][44] Finally, withdrawal was assessed but not reported in three studies and was not assessed at all in two studies. By not reporting withdrawal rates, the success of the weaning process in these studies may have been exaggerated.…”

Problematisation and regulation: Bodies, risk, and recovery within the context of Neonatal Abstinence Syndrome

“…Complicating matters, previous guidance on the care of pregnant women who are opioiddependent recommended reduction of methadone to 'the lowest possible dose' with some guidance proposing very low, sub-therapeutic levels (<40mgs/day) to avoid NAS (Wolff & Perez-Montejano, 2014). Although this guidance was superseded years ago because of mounting evidence against this advice, its legacy remains (Chandler, et al, 2013).…”

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

“…Chandler’s research is situated in the morally laden field of drug use during pregnancy and early parenthood. NAS is identified, monitored and treated in different ways (Hudak and Tan 2012, Knopf 2016, Wolff and Perez‐Montejano 2014). Requirement of NNU services emerges across the accounts as a clear signifier of ‘severe’ NAS’ (Chandler et al .…”