Systematic mixed-study review of nonpharmacological management of neonatal abstinence syndrome.

Sonya Macvicar,Lauren E Kelly

doi:10.1111/birt.12427

Abstract

Neonatal abstinence syndrome is a multisystem disorder resulting from exposure to maternal addictive substance use in pregnancy. Withdrawal is characterized by neonatal tremors, feeding difficulties, and sleep disruption. The aim of this systematic review is to explore the nonpharmacological management of infants at risk of neonatal abstinence syndrome after prenatal exposure. A systematic mixed-study review was conducted. A search of CINAHL, MEDLINE, AMED, PsycARTICLES, PsycINFO, and Web of Science was performed for relevant articles published between January 2007 and June 2018. Quantitative and qualitative data were extracted and thematic analysis undertaken. The findings were synthesized as a narrative summary. Fourteen studies were included in the review, of which nine were quality improvement initiatives and five explored complementary therapies. The most common components of nonpharmacological management were consolation therapy and rooming-in of mother and baby. Implementation strategies incorporated family integrated care and practitioner training in the evaluation of neonatal withdrawal. When nonpharmacological management was applied, there was a reduction in the need for pharmacotherapy and a shorter hospital stay for newborns. Potential barriers to effective management included unreliable assessment tools, judgmental practitioner attitudes, and limited breastfeeding promotion. Providing and optimizing nonpharmacological management for the infant at risk of neonatal abstinence syndrome improves outcomes by reducing their length of hospital stay and the need for pharmacotherapy.

Highlights

IntroductionNeonatal abstinence syndrome (NAS) is a multisystem disorder of adverse neurobehaviour [1]
Neonatal abstinence syndrome (NAS) is a multisystem disorder of adverse neurobehaviour [1]. It results from the exposure of the fetus to maternal use of illicit or prescription addictive substances during pregnancy
The search was conducted by two independent reviewers and the search strategy used a combination of the following keywords and terms: ‘neonatal abstinence syndrome’ OR AND

Summary

Introduction

Neonatal abstinence syndrome (NAS) is a multisystem disorder of adverse neurobehaviour [1] It results from the exposure of the fetus to maternal use of illicit or prescription addictive substances during pregnancy. The documented prevalence of NAS varies significantly between institutions and the number of neonates at risk of withdrawal is difficult to predict [3]. This stems from a number of factors including the hesitancy of women to self-report their illicit substance use due to its illegal nature, a fear of stigma and child custody concerns [2]. Neonatal abstinence syndrome is a multi-system disorder resulting from exposure to maternal addictive substance use in pregnancy. The aim of this systematic review is to explore the non-pharmacological management of infants at risk of neonatal abstinence syndrome following prenatal exposure

Methods

Results

Discussion

Conclusion