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

Inpatient Clinical Pathway for Evaluation and Treatment of Neonates/Infants with Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS)

Goals and Metrics
Patient Education
Provider Resources
Neonate/Infants Admitted for NAS/NOWS
Consider Maternal and Infant Screening and Testing
 
 
 
 
CHOP PHL N/IICU only
 
 
Eat Sleep Console (ESC) Scoring
ESC: Scoring Evaluation and Treatment Guidelines
 
 
  • Assess infant’s ability to do the following 3 elements with each care:
    • Eat: Breastfeed or take adequate volumes
    • Sleep: At least 1 hr undisturbed
    • Be Consoled: Within 10 mins
 
 
 
 
Infant Can Do 2 or 3 Elements
Improved
Infant Can Do 0 or 1 Element
Not improved
 
 
 
 
Discharge Criteria
  • Infant continues/becomes able to do 2 or 3 elements
  • and
  • At least 3–5 days after birth depending upon substance half-life
  • and
  • At least 48 hrs after last PRN morphine
 
 
Discharge Recommendations
  • Notify PCP prior to discharge and ensure follow-up appointment is scheduled
  • Coordinate discharge planning with Social Work
  • Refer to Early Intervention
  • Refer to developmental follow-up clinic if available, such as CHOP NFP-RISE
  • Confirm need for notification or reporting to
    Child Protective Services has been addressed
    for disposition
  • Review perinatal infectious exposure risk and
    ensure appropriate follow-up monitoring, such as hepatitis C testing
  • Can administer up to 4 PRN doses in 24 hrs
  • Consider scheduled morphine if > 4 PRN doses in 24 hrs
Improved
 
 
Not improved
Administer Scheduled Morphine
 
 
Improved
 
 
Not improved
Administer Second-Line Medications
Consider if > 1 mg/kg/day of scheduled morphine
 
 
Weaning Pharmacologic Treatment
Wean when stable for 12–24 hrs
Posted: April 2013
Revised: March 2025Editors: Clinical Pathways Team