Neonatal Abstinence Syndrome: Time for a Reappraisal.

Abstract

The opioid abuse problem in the United States has grown into an epidemic, with an estimated 2.5 million Americans currently dependent on heroin or prescription pain medications.1 One of the many consequences of this growing public health crisis has been a marked increase in the number of infants born to mothers who used opioids during pregnancy. The rate of neonatal abstinence syndrome (NAS), the syndrome of withdrawal these infants may suffer after birth, quintupled from 2000 to 2012.2 Often, these infants occupy NICU beds for weeks or even months.3 Despite these skyrocketing numbers, long lengths of stay, and an enormous strain on the medical system, our standard management of these infants has remained largely unchanged for decades. With a critical reappraisal of our current approach and an eye toward innovation, we can alter our entire paradigm for managing infants with NAS and create opportunities for significant improvements in both patient outcomes and health care expenditures. The current approach used by many institutions for the management of NAS has its roots in a study published >40 years ago. In 1975, the Finnegan Neonatal Abstinence Scoring System (FNASS) was developed and is now widely accepted as the primary tool to assess infants with NAS. The FNASS is a 21-item tool that lists signs of withdrawal and assigns a point value to …