Keeping Current with Best Practices for the Treatment of Infants with NAS

Posted by Andrew Meyer, MD on Feb 4, 2019 9:56:00 AM

With our updated Best Practices for Management of Infants with Neonatal Abstinence Syndrome (NAS), ProgenyHealth addresses some of the newest treatment methods, medication doses, transition of care needs, and long-term concerns for these infants.

Neonatal drug withdrawal can occur when newborn infants are exposed to medications or addictive substances in-utero or can occur following prolonged postnatal exposure.

NAS refers to a constellation of signs and symptoms resulting from opioid withdrawal after cessation of maternal drug supply at the time of delivery. Opioid use in women of child-bearing age is a growing concern as, according to the most recent data, one infant is born in the US with NAS every 15 minutes to a woman who used a variety of drugs during pregnancy. Given that the 32,000 annual cases of NAS lead to an increased average length of stay, and increases in hospital costs totaling $563 million, this aspect of the opioid epidemic has had a marked effect on the healthcare system as well as some of our society’s most vulnerable members: newborns.

Our new Best Practices document has been developed by the clinical experts at ProgenyHealth, which include neonatologists and pediatricians. These Best Practices were then reviewed and approved by a committee of practicing neonatologists to assure both their scientific accuracy and that they are consistent with clinical practice patterns.

One of the more promising developments in NAS practice is a new scoring framework known as  the Eating, Sleeping, Consoling (ESC) framework. ESC has been introduced as an alternative to the widely used Finnegan scoring system, which is well-accepted, but is rather subjective, leading to inconsistencies in care and potentially, a longer length of stay than alternate scoring frameworks.

In a 2017 study of 50 infants at Yale University, Finnegan scoring would have led to starting morphine therapy in 30 patients (60%). Morphine was started on only 6 patients (12%) using the ESC framework. Average length of stay was reduced from 22.5 days to 5.9 days with no readmissions or adverse events.

How we develop our NAS best practices...

Given the promise of ESC, we made sure to include it in our 2019 NAS Best Practices document to reflect cutting edge approaches being used to treat NAS as well as to give an overview and references to help clinicians learn more about this promising new treatment philosophy.

In our next blog article, we will review the 2019 ProgenyHealth Best Practices for Management of Infants with Neonatal Abstinence Syndrome and discuss the use of appropriate medications, weaning strategies and potential outpatient medication for treating infants with NAS. Subscribe to our NICU  blog now to receive this article and all of newest educational content via email.



Grossman MR, Berkwitt AK, Osborn RR, Xu Y, Esserman DA, Shapiro ED, Bizzarro MJ. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics. 2017; Jun;139(6). pii: e20163360. doi: 10.1542/peds.2016-3360

Jansson LM, Velez ML. Infants of drug-dependent mothers. Pediatrics in Review. 2011;32(1):5-12

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Topics: Blog, nas, neonatal abstinence syndrome

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