Management of neonatal abstinence syndrome: a national survey and review of practice

Michael J O'Grady ^1*, Jayne Hopewell ¹ and Martin J White ¹

¹ Coombe Womens and Infants University Hospital, Dublin, Republic of Ireland

^* To whom correspondence should be addressed. E-mail: michaelogrady{at}physicians.ie.

Accepted 7 January 2009

Abstract

Aim: To ascertain the present management of neonatal abstinence syndrome (NAS) in neonatal units in the United Kingdom (UK) and Ireland.

Methods: Postal questionnaire to 235 neonatal units, with telephone follow-up of non-respondents.

Results: The response rate was 90 %, 96 % of respondents had a formal NAS guideline. The median number of infants treated annually for NAS was 6 (range 1-100). The method of Finnegan was the most widely used scoring system (52 %). Morphine sulphate was the most commonly used first-line agent for both opiate (92 %) and polysubstance (69 %) withdrawal. Dosing regimens varied widely. Units using a maximum daily morphine dose of < 400 µg/kg/day were more likely to require addition of a 2nd agent (76% vs. 58%, p = 0.027). Phenobarbitone was the drug of choice to treat seizures secondary to both opiate and polydrug withdrawal in 73 % and 81% of units respectively. Twenty nine percent of units allowed infants to be discharged home on medication. Fifty eight percent of these allowed administration of opiates in the community and in almost half of cases this was managed by a parent. Mothers on methadone whose serology was positive for Hepatitis B and/or C were 4 times more likely to be discouraged from breastfeeding.

Conclusions: The majority of units currently use an opiate as the drug of first choice as recommended. Doses utilised and second agents added vary significantly between units. Many of our findings reflect the lack of high-quality randomised studies regarding management of NAS.