Pediatric Academic Societies Annual Meeting

Pediatric Academic Societies Annual Meeting

May 09, 2017
2 min read

Alternate treatment model for NAS offers comparable safety, less morphine use

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An alternative treatment protocol focusing on evaluation of the infant’s eating and sleeping habits, as well as their ability to be consoled, decreases opioid medication use among infants with neonatal abstinence syndrome without adverse effects, according to research presented at the 2017 Pediatric Academic Societies Meeting.

“We found that a common-sense approach based on the functional well-being of infants is a safe and more effective way to treat neonatal abstinence syndrome than traditional treatment guidelines,” Matthew Lipshaw, MD, FAAP, from the Yale-New Haven Children’s Hospital, said in a press release. “[This] substantially reduced exposure to opioids in these infants and better met patients’ needs.”

Matthew Lipshaw, MD
Matthew Lipshaw

Current treatment guidelines for neonatal abstinence syndrome (NAS) fall under the Finnegan Neonatal Abstinence Scoring System (FNASS), which has been used in hospitals since the 1970s. To describe and compare the researchers’ approach to the FNASS, they conducted a retrospective study of infants treated for NAS at their hospital.

All infants born between March 2014 and August 2015 above 35 weeks’ gestational age were included in the study if they were diagnosed with NAS. These children were cared for in both the general inpatient unit and the neonatal nursery.

Researchers gathered FNASS scores, but did not use them to guide treatment. Instead, the number of incidences were measured that would have led to using or increasing medication if using FNASS, as were the number of times morphine was actually started or increased for an infant using the “eating, sleeping and consolability” (ESC) guideline.  

Fifty infants were diagnosed with NAS at Yale-New Haven Children’s Hospital and had a combined total of 301 hospital days. Although their FNASS scores were associated with the start of morphine treatment in 60% of patients, only 12% started morphine when the ESC guidelines were used. When comparing days of treatment, the FNASS protocols indicated that initiation or increase of medication was warranted in 24.6% of days as opposed to 2.7% of days with the ESC approach.

The researchers also examined the protocol for instances in which morphine use should not be started or decreased. No medication administration or a decrease in morphine was justified for 65.8% of days using the FNASS, compared with 94.4% of days with the ESC approach.

“If you focus on the well-being of these infants rather than a list of symptoms, you are much less likely to start medication,” Lipshaw told Infectious Diseases in Children. —by Katherine Bortz.


Lipshaw M, et al. “A Novel Approach to Evaluating and Treating Infants with Neonatal Abstinence Syndrome.” Presented at: The Pediatric Academic Societies Meeting; May 6-9, 2017; San Francisco, CA.

Disclosure: The researchers report no financial disclosures.