Neonatal abstinence syndrome

Also known as NAS · NOWS · Neonatal opioid withdrawal syndrome · Neonatal drug withdrawal · Finnegan scoring · Eat Sleep Console · MOTHER trial neonatal outcomes

Exam-exhaustive fellowship reference on neonatal abstinence syndrome and neonatal opioid withdrawal syndrome — definition, epidemiology, mechanisms, Finnegan vs Eat-Sleep-Console assessment, non-pharmacologic care, opioid pharmacotherapy, maternal OAT implications (MOTHER/Suarez), differential diagnosis, breastfeeding, and non-punitive dyad care. FRANZCP-primary, globally tagged.

medium14 referencesUpdated 26 July 202612 min readVerification in progress

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10 MCQs

Meet the patient

A term infant is born to a 28-year-old woman stable on methadone maintenance through pregnancy. Day one is quiet. Day two brings a high-pitched cry, tremor when startled, sneezing, and frantic non-nutritive sucking. By day three she is not feeding well and the nurses are scoring her every few hours.^[1]^[3]

The registrar's first instinct is to escalate the morphine. The examiner's question is the whole topic in two parts: what did you try before the morphine, and what does this baby's withdrawal tell you about her mother's care?^[2]^[10]

References14Show

[1]Jones HE, Kaltenbach K, Heil SH, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure N Engl J Med, 2010.PMID 21142534
[2]Hudak ML, Tan RC; Committee on Drugs; Committee on Fetus and Newborn Neonatal drug withdrawal Pediatrics, 2012.PMID 22291123
[3]Kocherlakota P Neonatal abstinence syndrome Pediatrics, 2014.PMID 25070299
[4]Tolia VN, Patrick SW, Bennett MM, et al. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs N Engl J Med, 2015.PMID 25913111
[5]Patrick SW, Davis MM, Lehmann CU, Cooper WO Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012 J Perinatol, 2015.PMID 25927272
[6]Grossman MR, Berkwitt AK, Osborn RR, et al. An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome Pediatrics, 2017.PMID 28562267
[7]Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome N Engl J Med, 2017.PMID 28468518
[8]Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome Hosp Pediatr, 2018.PMID 29263121
[9]Wachman EM, Schiff DM, Silverstein M Neonatal Abstinence Syndrome: Advances in Diagnosis and Treatment JAMA, 2018.PMID 29614184
[10]Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn; Committee on Substance Use and Prevention Neonatal Opioid Withdrawal Syndrome Pediatrics, 2020.PMID 33106341
[11]Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017 JAMA, 2021.PMID 33433576
[12]Suarez EA, Huybrechts KF, Straub L, et al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy N Engl J Med, 2022.PMID 36449419
[13]Young LW, Ounpraseuth ST, Merhar SL, et al. Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal N Engl J Med, 2023.PMID 37125831
[14]American College of Obstetricians and Gynecologists Committee Opinion No. 711 Summary: Opioid Use and Opioid Use Disorder in Pregnancy Obstet Gynecol, 2017.PMID 28742670