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The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care
  1. Jason R Pryor1,2,
  2. Faouzi I Maalouf1,2,
  3. Elizabeth E Krans3,
  4. Robert E Schumacher4,
  5. William O Cooper1,5,6,
  6. Stephen W Patrick1,2,5,6
  1. 1Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
  2. 2Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee, USA
  3. 3Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Research Institute University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4Department of Pediatrics, University of Michigan Health Systems, Ann Arbor, Michigan, USA
  5. 5Vanderbilt Center for Health Services Research, Nashville, Tennessee, USA
  6. 6Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Stephen W Patrick, Mildred Stahlman Division of Neonatology, Monroe Carell Jr Children's Hospital At Vanderbilt, 11111 Doctor's Office Tower, 2200 Children's Way, Nashville, TN 37232-9544, USA; stephen.patrick{at}


As the prescription opioid epidemic grew in the USA, its impact extended to pregnant women and their infants. This review summarises how increasing rates of neonatal abstinence syndrome resulted in a need to improve care to pregnant women and opioid-exposed infants. We discuss the variations in care delivery with particular emphasis on screening at-risk mothers, scoring systems for neonatal drug withdrawal, type and duration of pharmacotherapy, and discharge safety.

  • Neonatology
  • Drug Withdrawal

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  • Twitter Follow Stephen Patrick @stephenwpatrick

  • Contributors JRP and SWP wrote the first draft of the manuscript. EEK wrote the first draft of the section on opioid use in pregnancy. FIM wrote the first draft of the section on the discharge of an infant with neonatal abstinence syndrome. RES wrote the first draft of the section on breast feeding of a substance-exposed infant. WOC provided critical edits and contributed to the concept of the review. All authors reviewed, critically edited and approved the final manuscript.

  • Funding NIH 5T32HD068256-05 and John and Leslie Hooper Neonatal-Perinatal Endowment Fund (JRP), National Institute on Drug Abuse of the National Institutes of Health under award number K23DA038720 (SWP), National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR000146 (EEK).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.