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Pharmacologic Management of Neonatal Abstinence Syndrome Using a Protocol

Gibson, Brandi L. MSN, RN, RNC-NIC; Coe, Kristi MSN, RN, NNP-BC, CPNP, CNCNS; Bradshaw, Wanda MSN, RN, NNP-BC

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000648
Clinical Issues in Neonatal Care

Background: The opioid epidemic in the United States has reached unprecedented proportions with far-reaching impacts on the most vulnerable population. The number of neonates born addicted to opioids has grown exponentially over the last several decades, leading to increased neonatal intensive care unit admissions and rising healthcare costs. Recent studies have yielded mixed results regarding which medication is most effective at relieving the symptoms of opioid withdrawal and reducing the weaning timeframe for babies with neonatal abstinence syndrome (NAS).

Purpose: To explore and compare the effectiveness of morphine versus methadone in the treatment for NAS using a standardized protocol.

Method: A literature search of PubMed and CINAHL was performed. The search yielded 10 quantitative studies that were analyzed for potential practice changes.

Conclusion: Based on current literature, following a standardized, stringent weaning protocol is more beneficial than the pharmacologic agent used. Studies reveal shorter weaning times and hospital stays in almost every group that followed rigid guidelines.

Implication for Research: Although current studies are promising for the desired outcome, more research is needed to develop appropriate protocol-based weaning regimens for management of NAS.

Implication for Practice: As the occurrence of NAS continues to rise, its management must vigorously meet the challenges of the diagnosis. Institutions should reevaluate their current protocols based on reassuring data showing that stringent guidelines using morphine or methadone can improve clinical outcomes, reduce hospital length, and lower healthcare costs.

Duke University School of Nursing, Durham, North Carolina.

Correspondence: Lieutenant Brandi L. Gibson, MSN, RN, RNC-NIC, Nurse Corps, US Navy, Duke University School of Nursing, Box 3322, Durham, NC 27710 (

All the authors have read and approved this article for publication and have all contributed equal substance to this work. This manuscript has not been submitted for consideration by another journal.

The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. LT Gibson is a military service member. This work was prepared as part of her official duties Title 17, USC, §105 provides that “Copyright protection under this title is not available for any work of the U.S. Government.” Title 17, USC, §101 defines a “U.S. Government work as a work prepared by a military service member or employees of the U.S. Government as part of that person's official duties.” Written work prepared by employees of the Federal Government as part of their official duties is, under the US Copyright Act, a “work of the United States Government” for which copyright is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses