title: Update on the pharmacologic management of neonatal abstinence syndrome.
abstract: Although a statement on Neonatal Drug Withdrawal was published in 1998 by the American Academy of Pediatrics, pharmacologic management of neonatal abstinence syndrome (NAS) remains a challenge. Published clinical trials are limited, restricting treatment decision making to practitioner's experience and preference rather than evidence-based medicine. To optimize withdrawal symptom prevention, drug selection is often based on the offending agent (opioids versus polysubstance exposure), clinical presentation, mechanism of action (agonist versus partial agonist/antagonist, receptor effects), pharmacokinetic parameters and available drug formulations. This review addresses risk factors and pathophysiology of NAS, summarizes parameters of common drugs used for the management of NAS, and reviews published literature of standard therapies as well as newer agents. Based on the current literature, paregoric is no longer recommended and oral morphine solutions remain the mainstay of therapy for opiate withdrawal. Other potential therapies include methadone, buprenorphine, phenobarbital and clonidine with the latter two agents as adjunctive therapies.
authors.affiliation: Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA 19104, USA. l.bio@usp.edu
authors.forename: L L
authors.initials: LL
authors.lastname: Bio
authors.forename: A
authors.initials: A
authors.lastname: Siu
authors.forename: C Y
authors.initials: CY
authors.lastname: Poon
mesh_terms: D001569:Benzodiazepines / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007231:Infant, Newborn; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D010634:Phenobarbital / Q000627:therapeutic use; D011247:Pregnancy
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics; D001569:Benzodiazepines; D002047:Buprenorphine; D003000:Clonidine; D008691:Methadone; D010634:Phenobarbital