Inpatient Pathway for the Evaluation/Treatment of Infants with Neonatal Abstinence Syndrome

Weaning Pharmacologic Treatment

Morphine Only

When NAS scores are stable, decrease morphine dose by 10% of the stabilizing dose once each day.

Allow 24-48 hours between morphine weans.

Discontinue morphine when infant has tolerated a dose of 0.12-0.16 mg/kg/day (0.02 mg/kg/dose) for 24-48 hours

Morphine + Phenobarbital

When NAS scores are stable, decrease morphine dose by 10% of the stabilizing dose once each day.

Allow 24-48 hours between morphine weans

When morphine has reach 0.3 mg/kg/day, then maintain dose and discontinue Phenobarbital.

Observe 48 hours.

If NAS scores remain stable, resume decreasing morphine dose 10% daily

Discontinue morphine when infant has tolerated a dose of 0.12-0.16 mg/kg/day (0.02 mg/kg/dose) for 24-48 hours

Morphine + Phenobarbital + Clonidine

When NAS scores are stable, decrease morphine dose by 10% of the stabilizing dose once each day.

Allow 24-48 hours between morphine weans

When morphine has reached 0.4 mg/kg/day (0.05 mg/kg/dose),
decrease Clonidine by 25% daily, until discontinued

Resume decreasing morphine dose 10% daily

When morphine has reach 0.3 mg/kg/day, then maintain dose and discontinue Phenobarbital.

Observe 48 hours.

If NAS scores remain stable, resume decreasing morphine dose 10% daily

Discontinue morphine when infant has tolerated a dose of 0.12-0.16 mg/kg/day (0.02 mg/kg/dose) for 24-48 hours

Phenobarbital only When NAS scores are stable, decrease Phenobarbital by 20% each day.