What is the optimal treatment for neonatal abstinence syndrome (NAS)?

Updated: Dec 20, 2017
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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Answer

The optimal treatment for neonatal abstinence syndrome has not been established. This is reflected in the considerable heterogeneity in the pharmacologic treatment of neonatal abstinence syndrome among different institutions. Many pharmacological agents have been used to treat neonatal abstinence syndrome. However, few randomized trials have compared the efficacy of the various pharmacological treatments. For opioid related neonatal abstinence syndrome, morphine and methadone are given as substitutes. Nonmorphine treatments (eg, phenobarbital, chlorpromazine, diazepam, clonidine) provide symptomatic relief.

Opioids are currently considered the first-line therapy. Second-line therapy has been phenobarbital. Phenobarbital has been effective for the treatment of opioid withdrawal seizures. Clonidine has been shown to be an effective and safe second-line medication for the treatment of NAS symptoms refractory to opioid therapy. [82]


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