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"Stable NAS score" is defined as all NAS scores less than 8 in the preceding 24 hours
 Morphine dose when scores are stable is defined as the "stabilizing dose"
 Allow 24-48 hours between medication weans to assess tolerance.
Do not change morphine dosing interval during wean. (Maintain at q3-4 hr interval)
 After discontinuing morphine, continue to perform NAS scoring q3-4 hours with feeds. If
NAS score is greater than 8, recheck in 2 hrs. If NAS score is still greater than 8, give a
"rescue dose" of morphine. The dose given should be equal to the most recently discontinued dose. If infant needs several "rescue doses", consider resuming prior morphine schedule.
Morphine Only
When NAS scores are stable, decrease morphine dose by
10% of the stabilizing dose once each day.
Allow 24-48 hours between morphine weans.
Discontinue morphine when infant has tolerated a dose of
0.12-0.16 mg/kg/day (0.02 mg/kg/dose) for 24-48 hours
When NAS scores are stable, decrease morphine dose by
10% of the stabilizing dose once each day.
Morphine + Phenobarbital
Allow 24-48 hours between morphine weans
When morphine has reach 0.3 mg/kg/day, then maintain dose and discontinue Phenobarbital.
Observe 48 hours.
If NAS scores remain stable, resume decreasing morphine dose 10% daily
Discontinue morphine when infant has tolerated a dose of
0.12-0.16 mg/kg/day (0.02 mg/kg/dose) for 24-48 hours
When NAS scores are stable, decrease morphine dose by
10% of the stabilizing dose once each day.
Morphine + Phenobarbital + Clonidine
Allow 24-48 hours between morphine weans

Phenobarbital only
Methadone
When morphine has reached 0.4 mg/kg/day (0.05 mg/kg/dose), decrease Clonidine by 25% daily, until discontinued
Resume decreasing morphine dose 10% daily
When morphine has reach 0.3 mg/kg/day, then maintain dose and discontinue Phenobarbital.
Observe 48 hours.
If NAS scores remain stable, resume decreasing morphine dose 10% daily
Discontinue morphine when infant has tolerated a dose of
0.12-0.16 mg/kg/day (0.02 mg/kg/dose) for 24-48 hours
When NAS scores are stable, decrease Phenobarbital by
20% each day.
Wean starts at 48 hours
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10% wean per day
If patient scores < 9 for 24-48 hours on a stable methadone wean, may consider discharge.
Discharge criteria include: reliable and comfortable family, comfortable PCP, SW evaluation, PCP follow-up with 48 hours then weekly, Neurodevelopmental follow-up.