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neonatal abstinence syndrome (nas)

Neonatal Abstinence Syndrome (NAS)

(212kb pdf)
(26kb pdf)
(19kb pdf)

Aim


The aim of the Neonatal Abstinence Syndrome (NAS) Clinical Practice Guideline (CPG) is to improve the identification and consistency of care of babies at risk of NAS. The document outlines antenatal care and assessments to identify babies at risk of NAS, care of babies at risk of NAS, treatment of NAS, and follow-up required for babies at risk of NAS.

CPG development process


The NAS CPG was developed by a multidisciplinary working group of paediatricians, midwives, pharmacist, counsellor, and managers from three tertiary health services (Mercy Hospital for Women, Southern Health and Royal Women’s Hospital). All working group members had expertise in services that provide care for babies at risk of NAS.

Neonatal Abstinence Syndrome Clinical Practice Guideline


Neonatal Abstinence Syndrome Clinical Practice Guideline
(212kb pdf)

Table of Contents

(as in NAS Clinical Practice Guideline pdf document )


Section


Topic


Page


1.
DEFINITIONS
3
2.
PRINCIPLES OF CARE
4
3.
MANAGEMENT OF PREGNANT WOMEN WITH ALCOHOL AND DRUG ISSUES
3.1
Detection of risk of neonatal abstinence syndrome
5
  • Table 1: Summary of effects on baby of in-utero substance exposure and baby assessments recommended
6
3.2
Additional antenatal investigations
7
3.3
Antenatal education
7
3.4
Assessment for Infant Home Based Withdrawal
7
3.5
Timing of Birth
7
3.6
Precautions
8
4.
MANAGEMENT OF BABY AT RISK OF NAS
9
4.1
Resuscitation
9
4.2
Differential diagnosis and investigations
9
4.3
Settings of care
10
4.4
Breastfeeding
10
4.5
Artificial Feeding
11
4.6
Assessment of withdrawal
11
4.7
Supportive therapy
12
4.8
Pharmacological treatment
12
  • Table 2: Recommended Morphine Treatment Regime
12
  • Table 3: Weaning off morphine treatment
13
  • Table 4: Vomiting
13
  • Table 5: Recommended phenobarbitone treatment regime
14
4.9
Infant Home Based Withdrawal
14
4.10
Discharge
16
4.11
Community discharge support
16
4.12
Follow-up for exposure to specific substances in pregnancy
17
4.13
Follow-up for babies at risk of vertical transmission of Blood Born Virus (BBV) (Hepatitis B, Hepatitis C and Human Immunodeficiency Virus)
17
  • Table 6: Summary of minimum follow-up required for babies at risk of NAS
18
5.
REFERENCES
19
6.
APPENDICES
21
Appendix 1:
Antenatal assessment for risk of Neonatal Abstinence Syndrome (NAS) flowchart
(26kb pdf)
22
Appendix 2:
Assessment tools for Infant Home Based Withdrawal
22
Appendix 3:
Assessment and care for babies at risk of Neonatal Abstinence Syndrome (NAS)
(19kb pdf)

25
Appendix 4:
Neonatal Abstinence Scoring System (NASS) and Guidelines
26
Appendix 5:
Scoring guide and modification for prematurity
28
Appendix 6:
The Royal Women’s Hospital: Neonatal Abstinence Syndrome (NAS) and Infant Home Based Withdrawal (IHBW)
29
Appendix 7:
The Royal Women’s Hospital, Infant Home Based Withdrawal (IHBW): Roles and responsibilities of team members
30


Published: 15 January 2008



The Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.

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