title: Review of the assessment and management of neonatal abstinence syndrome.
abstract: Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, 801 Mass Ave, 2nd Floor, Boston, MA 02118, USA. Sarah.Bagley@bmc.org.
authors.forename: Sarah Mary
authors.initials: SM
authors.lastname: Bagley
authors.forename: Elisha M
authors.initials: EM
authors.lastname: Wachman
authors.forename: Erica
authors.initials: E
authors.lastname: Holland
authors.forename: Susan B
authors.initials: SB
authors.lastname: Brogly
mesh_terms: D001942:Breast Feeding; D002047:Buprenorphine / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects*; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis* / Q000628:therapy*; D058850:Opiate Substitution Treatment / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000628:therapy
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D003000:Clonidine; D008691:Methadone