| Neonatal abstinence syndrome secondary to maternal opioid dependency: Guidelines for the Management of Substance Use During Pregnancy Birth and the Postnatal Period [7]: Pharmacological treatment of infants with NAS due to opioids should be initiated when the Finnegan or modified Finnegan score averages 8 or more on 3 consecutive scores or 12 or more on 2 consecutive scores.
Use of opioids for infants with NAS due to opioid withdrawal:
• An opioid (morphine) should be used as initial treatment for infants with NAS due to opioid withdrawal.
• Use of phenobarbitone or clonidine may reduce withdrawal severity in infants treated with an opioid.
A starting dose of morphine 0.5 mg/kg/day in four divided doses (six-hourly) is recommended. Doses should be titrated to NAS scores, that is, to control infant signs of NAS [8].
It is unclear from the evidence what the starting dose of opioid should be. Most trials have commenced morphine 0.2–0.5 mg/kg per day in divided doses. Doses were titrated to NAS scores (i.e. control of infant signs) [9]. [LOE I GOR B]
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