Neonatal abstinence syndrome: management and current concepts

Neonatal abstinence syndrome (NAS), a constellation of predominantly autonomic, neurological and gastrointestinal symptoms, is caused by neonatal withdrawal from in utero exposure of maternal misuse of illicit or prescribed drugs. The severity of NAS depends on time, type and combination of drugs taken and the feto-maternal metabolic rate. The physical and psychological consequences of NAS are manifold, contributing to the difficulty in its diagnosis and management. Most babies exposed to opioids in utero require some form of treatment, either supportive or pharmacological treatment. Treatment is guided using standardised clinical scoring systems the most common being the Modified Finnegan Score. Although NAS is diagnosed clinically other possible diagnoses must be considered and toxicological confirmation is often helpful. The long-term neurodevelopmental side effects of NAS are yet to be fully explored. Early multidisciplinary intervention is required, and family integrated care should be actively encouraged. This paper summarises the symptomatology, investigations and current proposed management of NAS.