Background: The evaluation and management of infants with neonatal abstinence syndrome
(NAS), the constellation of opioid withdrawal specific to newborns, have received renewed attention
over the past decade during a new epidemic of opioid use, misuse, abuse, and dependence. Infants
with NAS often endure long and costly hospital stays.
Objective: We aim to review recent literature on the management and outcomes of infants with, and at
risk for, opioid withdrawal.
Methods: We reviewed articles indexed in PubMed over the past 5 years that examined interventions
and/or outcomes related to the management of infants with NAS. Thirty-seven studies were included
in our review comprising 8 categories: 1) identification of infants at risk for NAS, 2) prenatal factors,
3) evaluation of signs and symptoms, 4) non-pharmacologic care, including rooming-in and breastfeeding,
5) standardization of traditional protocols, 6) pharmacologic management, 7) alternative
treatment approaches, and 8) long-term outcomes.
Results: Non-pharmacologic interventions, standardization of traditional protocols, and alternative
treatment approaches were all associated with improved outcomes. Lengths of stay were generally
lowest in the studies of non-pharmacologic interventions. Patients exposed to buprenorphine in utero
tended to have better short-term outcomes than those exposed to methadone. Longer-term outcomes
for infants with NAS appear to be worse than those of control groups.
Conclusion: The current epidemic necessitates both continued research, and the application of new
evidence-based practices in the assessment and treatment of newborns exposed to opioids in utero.
Projects focused on non-pharmacologic interventions appear to hold the most promise.