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Neonatal Abstinence Syndrome: Presentation and Treatment Considerations

Kaltenbach, Karol PhD; Jones, Hendree E. PhD

doi: 10.1097/ADM.0000000000000207

The increase in opioid use among the general population is reflected in pregnant women and neonatal abstinence syndrome (NAS) statistics. This increase has produced an unprecedented focus on NAS from both the political-judicial sphere and the medical community. Under the banner of fetal protection, judges and prosecutors have implemented punitive approaches against women who use prescribed and nonprescribed opioids during pregnancy, including arrest, civil commitment, detention, prosecution, and loss of custody or termination of parental rights. Within the medical community, questions have been raised regarding protocols to detect prenatal drug exposure at delivery, NAS treatment protocols, the need for quality-improvement strategies to standardize care and reduce length of stay for mother and infant, and the benefits of engaging the mother in the care of her infant. It is not uncommon for the expression of strong discordant views on these issues both between and among these political-judicial and medical constituencies. Closely examining the issues often reveal a lack of understanding of substance use disorders, their treatment, and the occurrence and treatment of NAS. This study provides an in-depth examination of NAS, including variations in presentation and factors that impact the efficacy of treatment, and also identifying questions that remain unanswered. Finally, 4 key areas on which future research should focus to guide both medical care and public policy are discussed.

Sidney Kimmel Medical College at Thomas Jefferson University (KK), Philadelphia, PA; UNC Horizons and Department of Obstetrics and Gynecology (HEJ), University of North Carolina at Chapel Hill, Chapel Hill, NC; and Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology (HEJ), School of Medicine, John Hopkins University, Baltimore, MD.

Send correspondence and reprint requests to Hendree Jones, PhD, Executive Director, UNC Horizons, Professor, Department of Obstetrics and Gynecology, UNC School of Medicine, 127 Kingston Drive, Chapel Hill, NC 27514. E-mail:

Received 24 October, 2015

Accepted 8 February, 2016

© 2016 American Society of Addiction Medicine