User:LDavis5/sandbox

Treatment[edit]
Treatment depends on the drug involved, the infant's overall health, abstinence scores (based on the Finnegan scoring system), and whether the baby was born full-term or premature. It is recommended to observe and provide supportive measure to infants who are at risk of neonatal abstinence syndrome in the hospital. Infants with severe symptoms may require both supportive measures and medicines. Treatment for NAS may require the infant to stay in the hospital for weeks or months after birth.

The goal of treatment is to minimize negative outcomes and promote normal development. Infants may be prescribed a drug similar to the one the mother used during pregnancy, and slowly decrease the dose over time. This helps wean the baby off the drug and relieves some withdrawal symptoms.

Infants with NAS may be born premature and may have trouble feeding, leading to low birth weights and restricted growth. Complications of NAS include seizures and an increased risk of death. After hospital discharge, the infant will continue to be monitored to prevent relapse, support growth, and provide caregiver education. Long-term monitoring into adolescence may be necessary as a 2019 meta-analysis gave evidence of some longterm cognitive and physical side effects associated with prenatal opioid exposure.

'''[delete] such as methadone and morphine to treat withdrawal symptoms. Buprenorphine may also be effective.'''

'''[delete] If the symptoms are severe, especially if other drugs were used, a second medicine such as phenobarbital or clonidine may be added. Breastfeeding may also be helpful if the mother is in a methadone or buprenorphine treatment program without other drug use.'''

Non-Medication[edit]
Non-pharmacological interventions are first-line treatment to support maturation of the neonate.

Common non-medication approaches include:


 * Adjusting physical environments
 * Infants with NAS symptoms may have hypersensitivity to light and sounds. Techniques such as darkening the room and eliminating surrounding sounds work to lessen the neonate's visual and auditory stimuli.
 * Swaddling
 * Swaddling (wrapping an infant firmly in a blanket) can help improve sleep, develop nerves and muscles, decrease stress, and improve motor skills.
 * Breastfeeding
 * Infants with NAS may have problems with feeding or slow growth, which require higher-calorie feedings that provide greater nutrition. It is beneficial to give smaller portions more often throughout the day. Breastfeeding promotes infant attachment and bonding, and is associated with a decreased need for medication, may lessen the severity of NAS, and lead to shorter hospital stays. A 2020 Cochrane Review investigating the different non-medication therapies and their effects on NAS was inconclusive on whether one non-medication therapy was better than another.

[can add study about mothers with substance abuse & breastfeeding]

Medication[edit]
Although non-pharmacological intervention remains first-line treatment, pharmacological intervention, when appropriate and indicated, can improve signs of neonatal withdrawal. Pharmacological intervention

Medication is used to relieve fever, seizures, and weight loss or dehydration.

When medication use for opiate withdrawal in newborn babies is deemed necessary, opiates are the treatment of choice; they are slowly tapered down to wean the baby off opiates.

Phenobarbital is sometimes used as an alternative, but is less effective in suppressing seizures; however, phenobarbital is superior to diazepam for neonatal opiate withdrawal symptoms. In the case of sedative-hypnotic neonatal withdrawal, phenobarbital is the treatment of choice. Clonidine is an emerging add-on therapy. A 2021systematic review found low-certainty evidence that phenobarbital lengthened hospital stays but resulted in a return to birth-weight more rapidly. Low-certainty evidence also showed phenobarbital reduced treatment failure rates compared to diazepam and chlorpromazine. There was also low-certainty evidence of increased hospitalization days with clonidine and opioid compared to phenobarbital and opioid.

Opioids such as neonatal morphine solution and methadone are commonly used to treat clinical symptoms of opiate withdrawal, but may prolong neonatal drug exposure and duration of hospitalization. A study demonstrated a shorter wean duration in infants treated with methadone compared to those treated with diluted tincture of opium. When compared to morphine, methadone has a longer half-life in children, which allows for less frequent dosing and steady serum concentrations to prevent neonatal withdrawal symptoms.

Babies with this condition often have severe diaper rash or other areas of skin breakdown, which requires treatment with a special ointment or cream. [NEED CITATION]