The opioid-exposed newborn: Assessment and pharmacologic management

Abstract

The infant exposed to opioids in utero frequently presents a challenge to the neonatal care provider in the assessment and treatment of symptoms of Neonatal Abstinence Syndrome (NAS) after birth. This review is intended to provide the health care professional with a brief review of current evidence and practical guidelines for optimal evaluation and pharmacologic management of the opioid exposed newborn.

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

“…Outcomes of this approach have never been rigorously evaluated, and clinical practices vary widely. [20][21][22] Although we continued to use scores as guides, we no longer strictly initiated, increased, or weaned morphine based on scores alone. We placed more emphasis on overall infant condition and prioritized concern for feeding difficulty, poor weight gain, inability to sleep, and inconsolability above items with fewer detrimental effects (ie, tremors, increased tone, sneezing, yawning) ( Table 2).…”

Neonatal Abstinence Syndrome Due to Opioid Abuse in Pregnancy

“…It provides a wider window of detection of gestational exposure, presumably as remote as the second trimester, when drugs begin to accumulate in meconium, but implementation of the test is difficult. The baby's or the mother's hair analysis reflects the last trimester but is expensive and can be implemented in only a small number of centers (3,4). In our cases, maternal drug abuse stories were apparent, so the diagnoses were performed easily based on the Finnegan scoring system, but we could not confirm the diagnosis with laboratory tests due to the lack of capability in our institution.…”

The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care

“…Established scoring systems quantify clinical signs of NAS, jitteriness/tremors, poor feeding/weight loss, loose stools, diaphoresis, tachycardia, excoriations, excessive crying/irritability and seizures 54. The most commonly used scoring tool for NAS is a modified Finnegan Scoring System.…”

“…The most commonly used scoring tool for NAS is a modified Finnegan Scoring System. This 19-item scale, a modified version of the original created in 1975,55 evaluates multiple signs related to NAS and helps guide treatment initiation and dosing 54. These scoring tools are semiobjective systems that suffer from poor interoperator reliability, particularly in regard to neurological symptoms 56.…”