title: Neonatal abstinence syndrome: Historical perspective, current focus, future directions.
abstract: BACKGROUND
  Neonatal abstinence syndrome (NAS) occurs following prenatal opioid exposure. It is characterized by signs and symptoms indicating central nervous system hyperirritability and autonomic nervous system, gastrointestinal tract, and respiratory system dysfunction.
  
  
  OBJECTIVE
  This article: (1) briefly reviews NAS history, including initial identification, assessment, and treatment efforts; (2) summarizes the current status of and current issues surrounding recent NAS assessment and treatment, and (3) details future directions in NAS conceptualization, measurement, and treatment.
  
  
  RESULTS
  Mortality rate estimates in neonates treated for NAS exceeded 33%, and surpassed 90% for un-treated infants during the late-1800s until the mid-1900s. The focus of both assessment and treatment over the past 50years is predominantly due to two forces. First, methadone pharmacotherapy for "heroin addiction" led to women in methadone maintenance programs who were, or became pregnant. The second was defining NAS and developing a measure of neonatal withdrawal, the Neonatal Abstinence Scoring System (NASS). Various NAS treatment protocols were based on the NASS as well as other NAS measures.
  
  
  CONCLUSIONS
  Future research must focus on psychometrically sound screening and assessment measures of neonatal opioid withdrawal for premature, term and older infants, measuring and treating possible withdrawal from non-opioids, particularly benzodiazepines, integrated non-pharmacological treatment of NAS, weight-based versus symptom-based treatment of NAS, and second-line treatment for NAS.
authors.affiliation: UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA. Electronic address: hendree_jones@med.unc.edu.
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
authors.affiliation: School of Nursing and Midwifery, Sansom Institute, University of South Australia, Adelaide, SA 5001, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fielder
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008691:Methadone / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000266:history; D058850:Opiate Substitution Treatment / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Neonatal abstinence syndrome; Neonatal opioid withdrawal; Opioid use disorder