Rachana Singh

Neonatal Abstinence Syndrome: Pharmacological Aspects

Abstract Neonatal abstinence syndrome (NAS) results from physiological dependence secondary to in utero exposure to maternal illicit as well as prescription drugs. Over the last few decades a significant increase in the infants undergoing NAS has been noted. NAS severity depends on multiple factors including genetics, type, number, dose and duration of drug exposure. The first line of treatment should always be nonpharmacological methods such as skin-to-skin care, minimal stimulation environment, and breastfeeding if not contraindicated, while keeping the mother–infant dyad together. If despite these measures symptoms worsen then pharmacological treatment should be utilized and should be specific for each infant based on a pharmacological rationale rather than attempting to use a one size fits all strategy. The most commonly used first line of treatment medications are neonatal morphine sulfate and methadone. Additional adjunct medications for difficult-to-treat infants include phenobarbital and clonidine as needed.