Neonatal abstinence syndrome: Historical perspective, current focus, future directions

• Effective treatment protocols for NAS have been developed in the past 50 years.
• Measurement of NAS was an important step in the treatment of NAS.
• Non-pharmacological treatments for NAS may reduce its severity.
• Research needs to focus on development on psychometrically sound measures of NAS.
• Research needs to focus on effective pharmacotherapy protocols for NAS.

BackgroundNeonatal abstinence syndrome (NAS) occurs following prenatal opioid exposure. It is characterized by signs and symptoms indicating central nervous system hyperirritability and autonomic nervous system, gastrointestinal tract, and respiratory system dysfunction.ObjectiveThis article: (1) briefly reviews NAS history, including initial identification, assessment, and treatment efforts; (2) summarizes the current status of and current issues surrounding recent NAS assessment and treatment, and (3) details future directions in NAS conceptualization, measurement, and treatment.ResultsMortality rate estimates in neonates treated for NAS exceeded 33%, and surpassed 90% for un-treated infants during the late-1800s until the mid-1900s. The focus of both assessment and treatment over the past 50 years is predominantly due to two forces. First, methadone pharmacotherapy for “heroin addiction” led to women in methadone maintenance programs who were, or became pregnant. The second was defining NAS and developing a measure of neonatal withdrawal, the Neonatal Abstinence Scoring System (NASS). Various NAS treatment protocols were based on the NASS as well as other NAS measures.ConclusionsFuture research must focus on psychometrically sound screening and assessment measures of neonatal opioid withdrawal for premature, term and older infants, measuring and treating possible withdrawal from non-opioids, particularly benzodiazepines, integrated non-pharmacological treatment of NAS, weight-based versus symptom-based treatment of NAS, and second-line treatment for NAS.