Neonatal Abstinence Syndrome: Management Advances and Therapeutic Approaches

In this review, we discuss the epidemiology, pathophysiology, and clinical presentation of opioid-exposed infants with particular focus on birth hospitalization and outpatient management. The opioid crisis has spread rapidly throughout the USA and has led to increasing numbers of infants born with neonatal abstinence syndrome (NAS). Inpatient management for NAS should optimize non-pharmacologic care with use of pharmacologic agents if needed. Clinical pathways that aim to optimize non-pharmacologic interventions and utilize functional assessments over numerical scoring tools have shown significantly reduced length of stay, cost, and proportion of infants receiving morphine. Further research should center on strategies to preserve the maternal-infant dyad, improve feeding, predict development of NAS through genetic and epigenetic studies, and understand and improve long-term neurodevelopmental outcomes. The number of infants affected by the opioid crisis and broad range of treatment strategies warrants immediate and sustained attention from the medical community. Non-pharmacologic interventions and support of the maternal-infant dyad are critical in improving outcomes for these vulnerable infants.