Presenter: Matthew Grossman, MD, FAAP
Summary: Treating Neonatal Abstinence Syndrome (NAS) traditionally has followed a standardized approach using the Finnegan Scoring System in which if there were three consecutive scores > 8 or two scores > 12, medications would be started. Common medications included tincture of opium or morphine. Medication doses would be adjusted or weaned, typically every other day, by Finnegan scoring.
A better approach is indicated with the 2012 AAP guidelines that indicate the first-line approach to NAS should be nonpharmacological. The approach should be that used for any crying baby, i.e., holding, swaddling, on-demand feeding, and parents rooming in with the infant. NAS infants without significant other medical problems are best cared for in a regular nursery or hospital unit rather than a NICU. With these simple interventions, some NAS infants may not need medications, and if they do, may be weaned sooner.
Additionally, medication management can be more successful if using combinations of a narcotic plus an additional agent such as clonidine or phenobarbital. Medications may be safely weaned more quickly than every other day. Using such a combined approach, the Yale New Haven Hospital has significantly reduced NAS infant LOS, total narcotic dose, and cost while increasing rates of breast feeding.
- Treat NAS first by providing high quality nursing care with infants out of an ICU, swaddled, fed and held when first exhibiting withdrawal symptoms.
- Use combination narcotic and other medication if pharmacologic treatment is needed.
- Wean aggressively by symptoms. TH
Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.