In Australia, there is a considerable prevalence of drug use during pregnancy, which largely accounts for adverse perinatal and hospital outcomes in infants born to these mothers. A substantial number of these infants are in need of diagnosis and treatment for Neonatal Abstinence Syndrome (NAS).1 NAS is a multifaceted and incompletely understood spectrum of signs of neonatal behavioral dysregulation.2,3 NAS reflects dysfunction in four domains: state control and attention, motor and tone control, sensory integration, and autonomic functioning. A myriad of factors contribute to NAS (i.e., epigenetics, preterm birth, nicotine), however intrauterine opioid exposure accounts for approximately 50% of cases.2,4 The variable nature of NAS allows for discrepancies in screening and management of at risk infants, especially in rural Australian settings.5
Scoring systems are used to indicate modes of management in infants with NAS,6 however there is a lack of evidence to support the validity of current scoring systems.2 Moreover, due to limited personnel and resources in certain clinical settings, clinicians tend to diagnosis based on clinical acumen of presenting symptoms rather than using the recommended scoring systems. In turn, more conservative management methods are implemented, such as swaddling as opposed to the Australian national guideline recommendation of morphine administration.5,7
This article attempts to synthesize all the available Australian evidence on the limitations of screening methods for NAS, supplemented with studies from the USA and Europe. Diagnosis of NAS will briefly be reviewed. Two major scoring systems will be discussed and analyzed; Lipsitz tool and Finnegan and Modified Finnegan Neonatal A...
... middle of paper ...
...ng in NAS, has an independent adverse effect on development.
Healthcare system perspective: What does the current literature suggest?
A 2004-2013 cross-sectional study, in the United States, highlighted a positive correlation between maternal drug use and infant admissions for treatment of NAS. This study also underscored a substantial increase in patient admissions, length of stay, and resource utilization for infants admitted to neonatal intensive care units (NICUs) with NAS.22 This study indicates the need for effective strategies for antenatal prevention of NAS (i.e., targeting maternal substance abuse) and postnatal treatment of these infants (discussed in previous sections). Analysis of antenatal prevention is not within the scope of this review, however it should be taken into consideration when evaluating approaches to managing issues associated with NAS.
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