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.
Highlights
Between 2000 and 2009, antepartum opioid use increased from 1.19 to 5.63 per 1000 live births in the United States
The objective of this review is to summarize available evidence on the assessment and management of infants exposed to opioids in utero, including assessment tools used for neonatal abstinence syndrome (NAS) scoring, nonpharmacologic interventions, and pharmacologic management of NAS
Assessment Of 368 articles identified through our search terms, eight pertained to the evaluation of assessment tools for NAS
Summary
Between 2000 and 2009, antepartum opioid use increased from 1.19 to 5.63 per 1000 live births in the United States. No medications are currently approved by the FDA for use in NAS management or prenatal opioid dependence. Buprenorphine and methadone are currently labeled as FDA Category C: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and wellcontrolled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”. In addition to the benefits of methadone or buprenorphine to treat withdrawal symptoms and reduce cravings, pregnant women in treatment may have access to other treatment such as counseling, infection screening, and fetal growth monitoring, which can lead to improved pregnancy and neonatal outcomes [11]. It is important that women have access to two effective treatment options and that both have reasonable safety profiles for the exposed fetus
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