Neonatal Abstinence Syndrome
Risks for developing NAS
• Opioids
– Opiate derivatives, interact with mu-opioid
receptor
• Abstinence syndrome (withdrawal) experienced
following variable length of repeated exposure
Risks for developing NAS
• “Narcotics”
– Definition
• Cocaine
• PCP
• Stimulants
– Amphetamine and derivatives
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Methamphetamine
Amphetamine
MDMA
Many others
Risks for developing NAS
• Other possible culprits?
– SSRI/SNRI
– marijuana
– Caffeine
– Tobacco
– Alcohol
– Everything else we “should not use”
Risks for developing NAS
• When does it happen
– Immediately
– 72-96 hours
– Weeks
– Never
Risks for developing NAS
• Breastfeeding
• Co-morbidities
– HIV
– Hep B, Hep C
Consequences of NAS
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Seizures
Temperature instability
Poor feeding
Hypoglycemia
Inadequate Sleep
Recognizing NAS
• Neonatal abstinence scales
– Most commonly used is Finnegan
– Several others avaiable
– Positive screen threshold is 8
– Score of 24 on any 2 or 3 scores leads to
intervention
Finnegan NAS scoring tool (handout)
• Example cases discussed with audience
• Practice with examples to determine score
• Will complete several scorings, discuss ease of
use of the tool
Therapy for NAS
• Ideally, replace the substance that is suddenly
missing
• Slowly reduce the exposure over time
Therapy for NAS
• Alternatively substitute another similar
substance
– Safety
– Availablilty
– Efficacy for symptom control
Therapy for NAS
• Possible approaches
– Replacement
• Chronic pain syndromes
• Continue to use original or similar substance
Morphine
– Substitution
• Illicit use of schedule I substances
• Heroin
– Use another mu opioid
» Methadone
» Burpenorphine +/- Naloxone
» Morphine
Therapy for NAS
• Possible approaches
– Symptom Relief
• Tylenol
• Clonidine
• Phenobarbitol (barbiturate)
Therapy for NAS
• Symptom Relief
– Antihistamines
– Restraint
Therapy for NAS
– Substitution (same class)
• Illicit use of schedule I substances
• Heroin
– Use another mu opioid
» Methadone
» Burpenorphine +/- Naloxone
» Morphine
Therapy for NAS
– Substitution (different class)
• Phenobarbitol
• Clonidine
Prevention
• Methadone
– Lower dose?
» No change in rate
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Buprenorphine
Naloxone
Fentanyl, MS-Contin (morphine)
SSRI