Inpatient Clinical Pathway for Evaluation and Treatment of Infants with Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS)
- Review Maternal factors, Urine Tox Screen
- Infant Tox Screen
- Consent Considerations
- Admission
Infants at Risk for NAS/NOWS
Maximize Non-Pharmacologic Interventions
Provide Family Support, Communication
Eat Sleep Console (ESC) Score
ESC: Scoring Evaluation and Treatment Guidelines
ESC: Scoring Evaluation and Treatment Guidelines
- Assess infant’s ability to do the following 3 elements:
- Eat: Breastfeed or take adequate volumes
- Sleep: At least 1hr undisturbed
- Be Consoled: Within 10 minutes
- Infant can do ALL elements:
- Continue non-pharmacologic care
- Continue observation
- Infant can do 1-2 of the elements:
- Maximize non-pharmacologic care
- Continue observation until improvement
- Infant can do NONE of the elements:
- Maximize non-pharmacologic care
- Continue observation until improvement
- Infant continues/becomes able to do ALL
elements (at least most times):- Observe infant at least 3-5 days after birth
(depending upon substance half-life) OR - Observe at least 48 hours after last PRN Morphine
- Observe infant at least 3-5 days after birth
- If infant continues to do NONE or ONE of the elements:
- Continue providing non-pharmacologic care
- Consider PRN Morphine (0.05mg/kg/dose)
- Morphine PRN
- Administer morphine PRN (0.05mg/kg/dose) q 3-4 hrs as needed, up to 4 PRN doses in a 24 hour period
- Scheduled Morphine
- Consider if > 4 PRN doses in 24 hours. Start at 0.05mg/kg/dose q 3hr
- Continue evaluation with the ESC tool
- 2nd Line Medications:
- Consider if > 1mg/kg/day of scheduled morphine
- Wean when stable for 24 hours
- Discharge Recommendations
- Ensure that a follow-up appointment is scheduled with the PCP by parent prior to discharge
- Notify PCP prior to infant’s discharge
- Refer to Early Intervention
- If mother is Hepatitis C positive, recommend ID follow up and testing
- Encourage postnatal support for mother/family
Posted: April 2013
Revised: September 2021
Authors: C. Migone, MD; A. Bustin, PharmD; N. Brutus, DO; S. Ghavam, MD; G. Jani, MD; A. Lembeck, DO;
A. Sosnovsky, MD and with approval of CHOP Newborn Network Pathway Committee
Revised: September 2021
Authors: C. Migone, MD; A. Bustin, PharmD; N. Brutus, DO; S. Ghavam, MD; G. Jani, MD; A. Lembeck, DO;
A. Sosnovsky, MD and with approval of CHOP Newborn Network Pathway Committee
Evidence
- A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome
- Reduction in Length of Stay and Morphine Use for NAS With the “Eat, Sleep, Console” Method
- Review of the Assessment and Management of Neonatal Abstinence Syndrome
- Successful Implementation of the Eat Sleep Console Model of Care for Infants With NAS in a Community Hospital
- Neonatal Opioid Withdrawal Syndrome
- Management of Newborns with Prenatal Opioid Exposure: One Institution's Journey
- Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome
Educational Media
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