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Current management of neonatal abstinence syndrome: a survey of practice in the UK and Ireland
  1. Sharon Dempsey1,
  2. Michael J O’ Grady1,2
  1. 1 Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Westmeath, Ireland
  2. 2 Women’s and Children’s Health, University College Dublin, Dublin, Ireland
  1. Correspondence to Prof. Michael J O’ Grady, Department of Paediatrics, Midland Regional Hospital Mullingar, Mullingar, Westmeath, Ireland; michael.ogrady{at}


Objective To study the current management practices of neonatal abstinence syndrome (NAS) throughout the UK and Ireland and identify changes in practice from the most recent survey in 2008.

Design Postal questionnaire to a consultant paediatrician or neonatologist in all 215 neonatal units in the UK and Ireland in January 2020.

Results Response rate was 62%. An objective scoring tool was used in 97% of units and the Finnegan score was favoured by 70%. Morphine sulfate use as first line for the treatment of opiate withdrawal was almost universal and 70% used a dose of 40 µg/kg every 4 hours (240 µg/kg/day). Phenobarbitone administration as a second-line agent for opiate withdrawal increased to 61% of units with significant reductions in chloral hydrate and chlorpromazine use compared with the previous survey. Morphine sulfate and phenobarbitone remain the preferred first-line and second-line agents, respectively, for polysubstance withdrawal. There was a significant increase in chlorpromazine use as first line for polydrug withdrawal (1.5–14.2%). The practice of units discharging infants’ home on medication increased to 46% from 29%. All units now permit breastfeeding in mothers taking methadone, compared with 81% previously.

Conclusion and relevance Compared with the previous survey, improvements in evidence-based practices were noted, highlighting the benefits of this type of research. Nonetheless, significant variation still exists in some aspects of the management of NAS. Post-discharge follow-up varies widely, with particular deficits in ophthalmology follow-up.

  • Intensive Care Units, Neonatal
  • Neonatology
  • Pharmacology
  • Social work

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. N/A.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. N/A.

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  • Contributors SD acquired, analysed data and wrote the preliminary manuscript draft. MJOG was involved in the conception and design of the study, analysis and interpretation of data and revision and editing the manuscript and agrees to act as guarantor for this work. Both authors have seen the final manuscript draft and agree to be accountable for its contents. Both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. No artificial intelligence-assisted technologies were used.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.