NEONATAL ABSTINENCE
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SYNDROME
Neonatal abstinence syndrome (NAS) is a multisystemic disorder resulting from chronic in-utero exposure to certain prescription or illicit
drugs and their abrupt cessation at birth.
Causes
Signs and symptoms
NAS can result from a wide variety
of substances consumed during
pregnancy, including: Onset, duration, and severity of symptoms vary greatly depending on the substance(s)
involved and patterns of prenatal use.
• Opioids
• Heroin • High-pitched cry • Sneezing
• Morphine • Hyperirritability
• Seizures • Excessive
• Fentanyl
• Sleep deprivation sucking
• Hydrocodone and fragmentation • Poor or exces-
• Oxycodone sive feeding
• Methadone • Tachypnea • Yawning
• Buprenorphine
• Benzodiazepines • Hypertension • Sweating
• Amphetamines • Tachycardia
• Cocaine • Hyperthermia
• Diarrhea
• Nicotine • Hypertonia
• Excessive weight loss
• Antidepressants • Tremors
• Vomiting
• SSRIs
• SNRIs
Non-pharmacological management Pharmacological
management
A non-pharmacologic approach is first-line in treatment of NAS:
Treatment is aimed at improving withdrawal signs
• Keep the parent-infant dyad together through rooming-in.
in the short-term and weaning as soon as NAS signs
• Educate and involve parents in all aspect of infant care. and symptoms are well controlled.
• Encourage breastfeeding unless there is an absolute
There is no consensus regarding preferred agent,
contraindication. Facilitate access to human donor milk, as needed.
regimen, or weaning protocol.
• Increase frequency of feeding and/or supplement with calorie-dense
formula to meet increased energy requirement.
• Facilitate frequent skin-to-skin contact, kangaroo care. Ongoing care
• Reduce stimuli: Cluster care, dim lights, reduce noise.
Close interdisciplinary follow-up is necessary after
• Vertical rocking, side-lying C position, and swaddling may reduce
discharge to meet the complex health needs of the
irritability and hypertonicity.
parent-infant dyad and connect them to community
• Individualize interventions to infant’s symptoms/response. resources.
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