Diazepam in the management of the neonatal narcotic withdrawal syndrome. Recent rise in rates of opiate replacement therapy among pregnant women have resulted in increasing number of infants requiring treatment for neonatal abstinence syndrome. Currently enrolled in a substance abuse treatment program. Neonatal abstinence syndrome management in california. Association of a simplified finnegan neonatal abstinence. Clonidine treatment of neonatal narcotic abstinence syndrome. Neonatal abstinence syndrome nas and treatment guidelines. Review article from the new england journal of medicine neonatal abstinence syndrome.
Neonatal abstinence score or finnegan score refer appendix 3 was developed to monitor the progress of infants experiencing neonatal abstinence due to opioid exposure in utero. Drug withdrawal, nas, nicu, opioid addiction, longterm outcomes. Identifying neonatal abstinence syndrome nas and treatment guidelines. Neonatal abstinence syndrome nas is a drug withdrawal syndrome that most commonly occurs in infants after in utero exposure to opioids, although other substances have also been associated with. Neonatal abstinence syndrome nas, a direct consequence of mmt during pregnancy. Neonates with prenatal exposure to mmt spent more days in the hospital 21 vs. Neonatal abstinence syndrome what you need to know 5 can i breastfeed my baby. The work group developed a template for members to consider as they develop their policy and procedures. Pdf maternal methadone treatment and neonatal abstinence. Early detection and holistic treatment that incorporates pharmacologic and nonpharmacologic. Aug 16, 2016 1 the problem of neonatal abstinence syndrome wanda barfield, md, mph capt,u. Neonatal abstinence syndrome, maternal opiate dependence, pharmacological treatment for opiate addiction, neonatal and longterm developmental outcomes the increased incidence of prenatal exposure to opiates reflects the rise in prescription opiate abuse due to changes in pharmacologic availability and diversion, a rapid addiction process, and social factors associated with disadvantage. The terminology neonatal opioid withdrawal syndrome nows will be used to describe the clinical condition addressed herein by this document and replaces neonatal abstinence syndrome nas used in previous indian health service ihs guidelines. Neonatal abstinence syndrome management from prenatal.
Describe the longterm effects of in utero opioid exposure on the. Neonatal abstinence syndrome nas royal cornwall hospitals. Phenobarbital is the first line additional therapy for polysubstance exposure and may be used in combination with opioid therapy for nas secondary to opiate withdrawal. Hospital variation in neonatal abstinence syndrome. Populations of women who may give birth to infants with nas include women who use heroin, women who use or misuse prescription opioids e. Treatment and pediatric outcomes neonatal abstinence syndrome nas is a result of the sudden discontinuation of fetal exposure to substances that were used or. Recommendations to the indian health service on neonatal.
The home environment, caregiver, and support team must be taken into consideration. Different medications have been used to ameliorate the symptoms of withdrawal, most commonly opioids. Emerging treatment options for neonatal abstinence syndrome nas this infographic compares the standard of care with emerging models for treating babies born with neonatal abstinence syndrome nas. Clinical policy neonatal abstinence syndrome guidelines page 2 of 8 48 hours and all of the discharge criteria in section i. Neonatal abstinence syndrome nas is a drug withdrawal syndrome that presents in newborns after birth when transfer of harmful substances from the mother to the fetus abruptly stops at the time of delivery. As a withdrawal syndrome, nas is characterized by dysregulation in central, autonomic and gastrointestinal system functioning. If the baby is not arousing for feedings or appears excessively sleepy, notify the physician for medication adjustment. It is defined as a constellation of behavioral and physiological signs and symptoms that are remarkably similar despite marked differences in the. Successfully complete the posttest complete the evaluation form date november 2018 november 2020 learning objectives describe the characteristics of neonatal abstinence syndrome nas.
The neonatal abstinence syndrome refers to a postnatal opioid withdrawal syndrome that can occur in 55 to 94% of newborns whose mothers were addicted to or treated with opioids while pregnant. Short and longterm developmental outcomes associated with prenatal opiate exposure are. Maternal drug use and neonatal abstinence syndrome nas are being seen across the united states. Neonatal abstinence syndrome nas neonatal clinical guideline v2.
Guide to assessment and scoring the neonatal abstinence syndrome scoring system was designed for term babies and. Graham, phd, patrice melvin, mph,a maria jorina, phd,a al ozonoff, phd. Neonatal abstinence syndrome nas is a constellation of symptoms. When admitting an nas baby, the order for scoring using the esc approach should be entered as a notify provider order as follows. The longterm outcomes of infants with neonatal abstinence. Treatment guidelines for neonatal abstinence syndrome.
Primary treatment of neonatal symptoms related to prenatal substance exposure should be supportive because pharmacologic therapy can prolong. It can be severe and cause long hospital stays after birth and with symptoms up to 6 months after birth. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Question what is the most effective pharmacological treatment for neonatal abstinence syndrome. Over the past two decades, increased prevalence of opioid use. If advised by your physician, breastfeeding may help your baby. Nursing applications include obtaining evidence for best practice through diligent searches of the literature and expert guidelines. You can use this infographic in presentations or other materials to build awareness for new models. There is substantial variability in how neonatal abstinence syndrome is diagnosed and managed.
This guideline outlines the management of infants exhibiting symptoms of neonatal. Neonatal abstinence syndrome clinical guidelines for pharmacologic treatment. Morphine is the firstline agent and the mainstay of treatment. Cdcs response to the opioid crisis involves strategies to prevent opioid overdoses and. Neonatal abstinence syndrome nas is a drug withdrawal syndrome that occurs among drugexposed primarily opioidexposed infants as a result of the mothers use ofdrugs during pregnancy 1. It will also be used to help plan your babys treatment. Neonatal abstinence syndrome clinical guidelines for. Clinical policy neonatal abstinence syndrome guidelines page 7 of 7 providers referred to in this clinical policy are independent contractors who exercise independent judgment and over whom the health plan has no control or right of control. Interventions for the treatment of neonatal abstinence. Treatment guidelines for neonatal abstinence syndrome provider quick tips and orders. Even after medical treatment for neonatal abstinence syndrome is over and babies leave the hospital, they may need extra tlc for weeks or months.
By 2014, one infant was born every 15 minutes in the us with the syndrome. Importance neonatal abstinence syndrome, which occurs as a result of in utero opioid exposure, affects between 6. Neonatal abstinence syndrome what you need to know. A new study to determine the extent, context, and costs of nas found that incidence of nas is rising in the united states. Evidencebased interventions for neonatal abstinence. Apr 12, 2020 the optimal treatment for nas has not been established. Department of human services neonatal abstinence syndrome. This large, multicenter quality improvement collaborative was effective in. It can be used as a trigger for pharmacological treatment of neonatal abstinence refer section 8.
Findings in this metaanalysis, buprenorphine was associated with the shortest length of treatment without additional adverse events. Neonatal opioid withdrawal syndrome the clinical findings associated with opioid withdrawal has been termed the neonatal opioid withdrawal syndrome nows. Pharmacologic interventions are commonly used as treatment for nas. Clonidine has also been evaluated both as an additive and alternative option for the treatment of opioid withdrawal symptoms. Nursing care for the infant with neonatal abstinence syndrome final. State strategies to address opioid use disorder among. Assessment and treatment of abstinence in the infant of the drug dependent mother. Neonatal abstinence syndrome nas toolkit risk factors, assessment and treatment the mha perinatal committee convened a work group of perinatalogists and neonatologists with the goal to better identify, screen and treat neonatal abstinence syndrome nas. Breastfeeding recommendations for women who receive. Since 1999, the rate of opioid use disorder oud has more than quadrupled, from 1. These guidelines specifically address the management of newborns to mothers with a history of opioid use or opioid dependence, including women currently receiving opioid substitution treatment methadone or buprenorphine or using prescription pharmaceutic al opioids such as. Nursing care for the infant with neonatal abstinence.
Neonatal abstinence syndrome overview neonatal abstinence syndrome nas refers to a constellation of signs in the newborn due to substance or medication withdrawal. Treatment of neonatal abstinence syndrome adc fetal. Aap guidelines drug therapy is indicated to relieve moderate. Nearly all exposed infants will display some symptoms, but only a subset require treatment. This cohort study identifies items on the finnegan neonatal abstinence scoring tool fnast that are independently associated with the decision to use pharmacologic therapy and simplifies the tool while minimizing loss of information for the treatment decision. Send urine and meconium for toxicology screening for. Blood, urine, or meconium samples may be tested for drugs. Hospital variation in neonatal abstinence syndrome incidence. The mha perinatal committee convened a work group of perinatalogists and neonatologists with the goal to better identify, screen and treat neonatal abstinence syndrome nas.
Neonatal abstinence syndrome is a generalised disorder presenting a clinical picture. Can other conditions produce the same symptoms as neonatal abstinence syndrome. Providers are not agents or employees of the health plan. Use of opiates during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome nas. Neonatal abstinence syndrome occurs at birth as a result of intrauterine exposure to opioids or highdose benzodiazepines. Magnitude of the problem between the years 2000 and 2009, national. Fact sheet neonatal abstinence syndrome in connecticut. Feb 03, 2020 a neonatal abstinence syndrome score is used to evaluate your babys signs of dependence and withdrawal.
Opioid prescription use among women of reproductive age and pregnant women. Evidencebased interventions for neonatal abstinence syndrome. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. Evidencebased care guideline neonatal abstinence syndrome. Trusted answers from the american academy of pediatrics. Objective this article aims to describe neonatal outcomes, clinical correlates, and the rate for neonatal abstinence syndrome nas for women on methadone maintenance therapy. Neonatal withdrawal after intrauterine exposure to certain drugs illicit or prescription occurs with the abrupt cessation of the drug exposure at birth. The neonatal abstinence syndrome framework overview the neonatal abstinence syndrome nas framework is a revised version of the supplement to asthos 2015 issue brief, how state health departments can use the spectrum of prevention to address neonatal abstinence syndrome. Neonatal abstinence syndrome nas frequently asked questions.
Consultant led neonatal guidelines meeting approved. The college of physicians and surgeons of ontario has established program standards and clinical guidelines for. Identifying neonatal abstinence syndrome nas and treatment. The clinical presentation of a newborn with nas can include gastrointestinal, neurologic, vasomotor and respiratory symptoms. Neonatal withdrawal syndrome, generically termed neonatal abstinence syndrome nas, is a complex disorder. Neonatal abstinence syndrome causes, symptoms, scoring. Novel pharmacotherapeutic strategies for treatment of opioidinduced neonatal abstinence syndrome gabrielle l. The long term outcomes for these infants require ongoing support and are important to understand and address. Many other conditions can produce the same symptoms as neonatal abstinence syndrome. Some babies born to opioid using pregnant women may experience neonatal abstinence syndrome nas. Nas most frequently is a result of opioid use in the mother but may also occur as a result of exposure to benzodiazepines and alcohol.
Neonatal abstinence syndrome nas is suffered by infants withdrawing from substances on which they have become physically dependent after in utero exposure. Management of neonatal abstinence syndrome in the newborn. Neonatal abstinence syndrome after methadone or buprenorphine exposure. Assessment of newborns with nas can often present as a challenge to maternal. Public health service director, division of reproductive health national center for chronic disease prevention and health promotion. The rise of neonatal abstinence syndrome occurred with concurrent increases in opioid use and opioid use disorder among pregnant women. Neonatal abstinence syndrome health effects experienced by infants born to mothers experiencing substance use disorder why its important neonatal abstinence syndrome nas is a constellation of signs of withdrawal in newborns neonates less than 28 days following in utero exposure to medications or illicit drugs, most commonly opioids. Neonatal abstinence syndrome aap pointofcaresolutions. Request pdf treatment of neonatal abstinence syndrome neonatal abstinence syndrome nas is suffered by infants withdrawing from substances on which they have become physically dependent after. Nas occurs with withdrawal disturbances in response to the cessation of the pregnancy exposure. Assessment of newborns with nas can often present as a challenge to. Comparison of safety and efficacy of methadone vs morphine for treatment of neonatal abstinence syndrome.
Treatment of neonatal abstinence syndrome request pdf. Neonatal withdrawal after intrauterine exposure to certain drugs illicit or prescription occurs with the. You can use this infographic in presentations or other materials to. The efficacy of few, however, have been adequately investigated. Pharmacological treatments for neonatal abstinence syndrome. Neonatal abstinence syndrome nas occurs in infants exposed to opiates or illicit drugs during pregnancy. Neonatal withdrawal after intrauterine exposure to certain drugs illicit or prescription. The frameworks intent is to aid in structuring stakeholder discussions. Neonatal abstinence syndrome nas toolkit minnesota hospital. Hospital variation in neonatal abstinence syndrome incidence, treatment modalities, resource use, and costs across pediatric hospitals in the united states, 20 to 2016 carly e.
Fact sheet neonatal abstinence syndrome in connecticut may 2016 the growing epidemic of nas in connecticut background and data source this fact sheet highlights the overall magnitude and economic impact of opioid withdrawal among infants in connecticut. Substance dependence treatment summary bnfc content. It is generally safe for mothers to breastfeed if they are in a stable treatment program, even if you. They may require prolonged treatment and spend weeks or even months in hospital. Neonatal abstinence syndrome treatment can last from 1 week to 6 months. 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. Neonatal abstinence syndrome nas, also called neonatal opioid withdrawal syndrome, is the result of inutero exposure to opioids. Neonatal abstinence syndrome guidelines nsw health. There is considerable diversity in the management of neonatal abstinence syndrome.
Neonatal abstinence syndrome american academy of pediatrics. Infants whose score was 8 or above were treated pharmacologically finnegan lp, et al. Once your baby is home, symptoms of withdrawal may still continue for several weeks. Neonatal abstinence syndrome pilot process neonatal abstinence syndrome nas is a drug withdrawal syndrome that presents in newborns after birth when transfer of harmful substances from the mother to the fetus abruptly stops at the time of delivery. Describe the characteristics of neonatal abstinence syndrome nas.
Although there is much research regarding neonatal abstinence syndrome nas, the majority of future research needs to be at a higher level of evidence. Guidelines for perinatal services, eighth edition, appendices, 20. Neonatal abstinence syndrome treatment guidelines feb20. Data evaluating the use of clonidine for the treatment of nas. One third of reproductiveaged women filled a prescription for an opioid medication 14%22% of women filled an opioid medication prescription duringpregnancy.
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