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
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
NAS < 24
Observation, NAS Score every 3-4 hrs
Short Half-Life
Long Half-Life

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
Non Opioid or Unknown
High NAS Score
First Line Morphine
> 1mg/kg/day required

Second Line

Posted: April 2013
Revised: February 2016, March 2017, January 2018, June 2018, January 2019
Authors: C. Hufnal, MD; J. Chuo, MD; J. Evans, MD; H. Monk, PharmD