Neonatal abstinence syndrome: Identification and management

SummaryNeonatal abstinence syndrome (NAS) describes the withdrawal symptoms of infants who are exposed to substance abuse in utero and become physically dependant on them. The most reliable method of confirming the diagnosis is analysis of meconium passed in the first days after birth. Many medications have been used to try and alleviate NAS symptoms, but their efficacy has rarely been tested in randomised or even quasi-randomised trials. The limited data available highlight that phenobarbitone has advantages over supportive care alone or diazepam, but opiates rather than phenobarbitone are the better treatment for the NAS seen in infants of opiate-dependant mothers. Opiate treatment is associated with less treatment failure and a reduced duration of treatment and neonatal unit admission. Appropriately designed trials with long-term outcomes are required to test the effectiveness of both pharmacological and non-pharmacological strategies for NAS, particularly due to maternal polydrug use.