Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS) Clinical Pathway, Inpatient – Scoring Evaluation and Treatment

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

ESC Scoring Evaluation and Treatment Guidelines

Assessment Initial Management Continued Care
Infant Can Do 2 to 3 of the Elements Observe for 3-5 days depending on exposed substance’s half-life before discharge
Infant Can Do 0 or 1 of the Elements
  • If ability to perform elements improves, observe for a total of 3-5 days depending on exposed substance’s half-life before discharge
  • If increasing difficulty performing some of the elements, consider continued inpatient observation and/or PRN morphine until improvement noted
  • If > 4 doses of PRN morphine in 24 hrs, consider scheduled morphine
    ESC: Scheduled Morphine
  • If infant requires > 1 mg/kg/day of scheduled morphine, consider second line medication
    Second-Line Medications
  • If infant requires scheduled morphine or second line medications and is stable for 12-24 hrs, start weaning pharmacologic treatment
    ESC: Wean Pharmacologic Treatment