Uncoordinated care of neonatal abstinence syndrome (NAS)

Issues: In the US, over 4.4% of pregnant women abuse one or more substances during pregnancy. For those pregnant women who abuse a harmful substance, most abuse multiple substances, exposing the fetus to many harmful chemicals during critical development phases. NAS is the withdrawal syndrome infants suffer from when substances that they have become physically dependent on in utero are abruptly discontinued after birth. The mechanisms underlying NAS symptoms are multifactorial in nature and unique to each infant, making it difficult to concretely assess and treat affected infants.  Currently, there is no standard method of care to treat infants with NAS.

Description: An intensive literature review constituted the research for this public health analysis, including over 100 peer-reviewed journal articles and two books.

Lessons learned: A number of standardized tests to assess NAS symptoms exist; however, not all providers implement them properly.  Most regimens of care rely heavily on pharmacological methods, even thought there is evidence for nonpharmacological and alternative therapies.

Recommendations: Care for this population of women requires coordinated efforts of health care providers, including obstetricians, neonatologists, pediatricians, drug treatment counselors, and nurses.  Optimal care for the dyad during the perinatal period can help decrease difficulties caused in utero.  NAS is one of the most challenging conditions neonatal nurses treat and improving care for NAS infants requires educating nurses and other providers on how to best care for them.  Future policies that support routine drug screening of mothers should include integrated care systems for addicted women and drug-exposed infants.