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Update on the pharmacologic management of neonatal abstinence syndrome

Journal of Perinatology volume 31, pages 692–701 (2011)Cite this article

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Abstract

Although a statement on Neonatal Drug Withdrawal was published in 1998 by the American Academy of Pediatrics, pharmacologic management of neonatal abstinence syndrome (NAS) remains a challenge. Published clinical trials are limited, restricting treatment decision making to practitioner's experience and preference rather than evidence-based medicine. To optimize withdrawal symptom prevention, drug selection is often based on the offending agent (opioids versus polysubstance exposure), clinical presentation, mechanism of action (agonist versus partial agonist/antagonist, receptor effects), pharmacokinetic parameters and available drug formulations. This review addresses risk factors and pathophysiology of NAS, summarizes parameters of common drugs used for the management of NAS, and reviews published literature of standard therapies as well as newer agents. Based on the current literature, paregoric is no longer recommended and oral morphine solutions remain the mainstay of therapy for opiate withdrawal. Other potential therapies include methadone, buprenorphine, phenobarbital and clonidine with the latter two agents as adjunctive therapies.

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Acknowledgements

We acknowledge Sarah A Spinler for editorial review.

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Authors and Affiliations

  1. Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA

    L L Bio & C Y Poon

  2. Department of Pharmacy Practice and Pharmacy Administration, Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, Clinical Neonatal/Pediatric Pharmacotherapy Specialist, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ, USA

    A Siu

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Correspondence to L L Bio.

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Supplementary Information accompanies the paper on the Journal of Perinatology website .

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Bio, L., Siu, A. & Poon, C. Update on the pharmacologic management of neonatal abstinence syndrome. J Perinatol 31, 692–701 (2011). https://doi.org/10.1038/jp.2011.116

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