An Epidemic of Neonatal Abstinence Syndrome

Laura A. Stokowski, RN, MS


March 04, 2015

Management of Neonatal Abstinence Syndrome in the Newborn Nursery

Artigas V
Nurs Womens Health. 2014;18:509-514

According to Artigas, an epidemic of maternal drug use during pregnancy is surfacing in the United States, with a concomitant rise in the diagnosis of neonatal abstinence syndrome (NAS) among offspring. The array of drugs associated with NAS is vast and includes both prescribed and illicitly used agents: opioids, antidepressants, nicotine, alcohol, benzodiazepines, barbiturates, marijuana, amphetamines, cocaine, and methamphetamine, to name a few.

In this review article, Artigas describes the short- and long-term effects of prenatal exposure to drugs. These effects can be profound, affecting neurobehavior, cognition, and language, or the impairments can be milder. Artigas points out the difficulty of separating the effects of drug exposure and the environmental influences in the home of the child whose mother took drugs during pregnancy.

NAS is seen most often following exposure to opioids, but it can also be induced by exposure to antidepressants, central nervous system stimulants, and hallucinogens. The pattern of neonatal behaviors seen in infants exposed to selective serotonin reuptake inhibitors, for example, is clinically similar to that following opioids and other drugs but may be caused by exposure to, rather than withdrawal from, the antidepressant agents. Polydrug use can make the prediction of neonatal effects difficult. NAS is typically manifested by neurologic, gastrointestinal, and autonomic dysfunction, and the affected newborn exhibits a state of hyperirritability that is exacerbated by environmental stimuli.

The author delineates the practice implications of prenatal drug exposure and NAS, which include both pharmacologic and nonpharmacologic interventions comprising mainly supportive care strategies. Although such measures as a quiet environment with low lighting, soft voices, clustering of care, swaddling and pacifiers to promote self-soothing, vertical rocking, and frequent, smaller-volume feedings have not been proven to be of benefit through research, by expert consensus they constitute the current standard of care for the drug-exposed or withdrawing infant.

For infants who don't respond to the soothing techniques of supportive care, pharmacologic first-line options are oral morphine and methadone, with or without clonidine. Phenobarbital is commonly used for abstinence from sedative hypnotic agents. Regardless of therapy, use of a validated and reliable clinical assessment tool is considered essential to gauge the extent of symptoms and monitor changes in symptoms with therapy or time.

Artigas emphasizes the importance of family-centered care for mother and newborn, a goal that can be difficult to achieve if the neonate is transferred to an intensive care setting. In addition to keeping the mother and baby together, nurses should assess and provide education of the family unit in coping and parenting skills.


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