title: How long should infants at risk of drug withdrawal be monitored after birth?
abstract: OBJECTIVE
  Neonatal abstinence syndrome (NAS) is an increasingly common disorder diagnosed in infants exposed to various drugs, causing immense financial and social burden. Recommendations from various bodies are for babies to be monitored for 4 to 7 days following birth so that prompt treatment can commence should symptoms develop. We aimed to determine the best post-natal observation period in babies at risk of NAS.
  
  
  METHODS
  A retrospective review was undertaken of infants ≥35 weeks' gestation who received treatment for NAS in the period 2001-2010. During this time, the standard post-natal observation period was a minimum of 7 days. Data including drug exposure, day of admission and day of treatment were collected.
  
  
  RESULTS
  Two hundred and ten babies were included. Drug exposure was predominantly to opiates (99%); however, most infants (58%) were exposed to additional substances (benzodiazepines, cannabis or amphetamines). Ninety-five per cent of infants were admitted by day 5 of life. Of the babies treated by day 7, 98.5% had been admitted to the nursery by day 5. Infants with polydrug exposure were admitted significantly earlier; however, time to treatment was not significantly different to those exposed to opiate replacement therapy alone.
  
  
  CONCLUSIONS
  In our hospital, babies treated for NAS often required admission before day 5. This has implications for hospital resource allocation, suggesting that routine post-natal observation for NAS could be shortened to 5 days. Further research is needed to help identify neonates who require more careful post-natal observation.
authors.affiliation: Newborn Services, Parkville, Victoria, Australia.
authors.forename: Cameron L
authors.initials: CL
authors.lastname: Smirk
authors.forename: Ellen
authors.initials: E
authors.lastname: Bowman
authors.forename: Lex W
authors.initials: LW
authors.lastname: Doyle
authors.forename: Camille Omar Farouk
authors.initials: CO
authors.lastname: Kamlin
mesh_terms: D000662:Amphetamines / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D002188:Cannabis / Q000009:adverse effects; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D000431:Ethanol / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007231:Infant, Newborn; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D014026:Nicotiana / Q000009:adverse effects
chemical_list: D000662:Amphetamines; D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D000431:Ethanol
keywords: drug withdrawal; monitoring; neonatal abstinence syndrome; treatment