Inpatient Pathway for the Evaluation/Treatment of Infants with Neonatal Abstinence Syndrome
Screening Infants to assess risk for Neonatal Abstinence Syndrome (NAS)

Maternal, infant factors
Indications for Toxicology screen

Infants at Risk for NAS
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Modified NAS Score
24 Rule
3 consecutive scores ≥ 8 or
2 consecutive scores ≥ 12
Begin at 2 hours of life
30-60 minutes after feed
Every 3-4 hours
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NAS < 24
Observation, NAS Score every 3-4 hrs
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Short Half-Life
Long Half-Life
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Observe for 72 hours

Discharge if NAS stable

Observe for 5-7 days
Consider earlier discharge if:
  • NAS stable
  • Home situation stable
  • Appropriate f/u arranged
NAS ≥ 24
Pharmacologic Intervention Required
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Non Opioid or Unknown
Opioid
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High NAS Score
First Line Morphine
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Morphine
> 1mg/kg/day required
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Second Line
Phenobarbital

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Posted: April 2013
Revised: February 2016, March 2017, January 2018, June 2018
Authors: C. Hufnal, MD; J. Chuo, MD; J. Evans, MD; H. Monk, PharmD