Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS) Clinical Pathway, Inpatient – Pharmacologic Treatment Recommendations

Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS), Clinical Pathway, Inpatient

ESC: PRN Morphine Recommendations

Initiate pharmacologic treatment when infant can do none or one of the elements of the ESC Score.

Morphine Dose Route Comments
0.05 mg/kg/dose every 3-4 hrs
  • PO
  • Administer morphine every 3-4 hrs only as needed.
  • Continue to evaluate infant using the ESC score.
  • Observe infant with cardiorespiratory monitor and pulse oximetry for at least
    4-6 hrs after the PRN dose of morphine is administered. May be done in the mother’s room if remote monitoring is available.
  • If infant requires > 4 PRN doses of morphine within 24 hrs, consider scheduled morphine.

ESC: Scheduled Morphine Recommendations

Consider when > 4 PRN morphine doses are required in a 24-hour period.
Monitor with cardiorespiratory monitor and pulse oximetry if receiving scheduled morphine.

Morphine Dose Route Comments
0.05 mg/kg/dose every 3-4 hrs with feeds
  • PO
  • Initial Dose
    • Use birth weight to calculate initial morphine dose
  • Dose increase
    • Increase dose 10-20% if not able to eat, sleep, or be consoled for 12 hrs
    • Increase dose every 12-24 hrs until symptoms are controlled
  • Second-Line Medication
    • Consider if symptoms not controlled on a total daily dose > 1 mg/kg/day
      of morphine
  • Weaning
    • Allow infant to stabilize for 24 hrs before beginning to wean