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Care of the Infant With Neonatal Abstinence Syndrome: Strength of the Evidence

Maguire, Denise PhD, RN

The Journal of Perinatal & Neonatal Nursing: July/September 2014 - Volume 28 - Issue 3 - p 204–211
doi: 10.1097/JPN.0000000000000042
Feature Articles: Continuing Education

There is little empirical evidence that guides management of infants with neonatal abstinence syndrome. The standard of care first described in the 1970s is still prevalent today, although it has never been tested in this population. Standard of care interventions include decreasing external stimulation, holding, nonnutritive sucking, swaddling, pressure/rubbing, and rocking. These interventions meet the goals of nonpharmacologic interventions, which are to facilitate parental attachment and decrease external stimuli. Many nursing interventions used in infants with neonatal abstinence syndrome have been tested in low-birth-weight infants, whose treatment often includes the same goals. Those interventions include music therapy, kangaroo care, massage, and use of nonoscillating water beds. Nursing attitude has also been shown to be impactful on parental attachment. The American Academy of Pediatrics recommends breast-feeding in infants whose mothers are on methadone who do not have any other contraindication. It also provides guidelines for pharmacologic management but cannot provide specific recommendations about a standard first dose, escalation, or weaning schedule. Buprenorphine has some evidence about its safety in newborns with neonatal abstinence syndrome, but high-powered studies on its efficacy are currently lacking. There are many opportunities for both evidence-based projects and nursing research projects in this population.

College of Nursing, University of South Florida, Tampa.

Corresponding Author: Denise Maguire, PhD, RN, College of Nursing, University of South Florida, MDC 22, Tampa, FL 33612 (

Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: September 10, 2013; accepted for publication: May 20, 2014.

© 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins.