Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a constellation of signs involving the central and autonomic nervous, respiratory, and gastrointestinal systems, that typically appear in the first few days after delivery in infants exposed to opioids and other substances in utero. This chapter uses a case study to highlight some of the history and evolution in the scientific literature on NAS, including the results of many recent reviews. Changing practices around treatment options for pregnant people with opioid use disorder are examined, including medically supervised withdrawal, agonist treatment with methadone and buprenorphine, and antagonist treatment with naltrexone. Maternal medication dose and other factors associated with NAS outcomes, like breastfeeding and rooming in, are also considered and the involvement of child protective services with these families is discussed. In addition, shifts in how NAS is assessed are examined, including clinical judgment, weighted points-based assessments of NAS signs, and a simplified assessment of neonatal functioning. Pharmacotherapies for treating NAS and the neurodevelopmental outcomes of exposed neonates are also considered.